New Patient Forms
Download the registration forms, fill them in by hand and bring them to your first visit.
What the PDF includes
- Patient registration: patient, responsible party, emergency contact and insurance details
- Medical history
- Smile evaluation
- Financial policy
- Consent for treatment
- Acknowledgement of receipt of our Notice of Privacy Practices
Any trouble with the forms? Call us on 312-944-9355 and we will help you complete them when you arrive.
Request an appointment today
Quickly and easily request your appointment online today.
After hours: 312-910-0995