Patient Online forms

To save yourself some time on the first appointment, you can fill out our patient forms at home. Download and print our patient forms here. If you have any questions, please feel free to call our office at 224 654-6543.

Patient Information Forms:

• Medical/Dental History
• Financial Policy
• HIPPA Privacy Policy
• Insurance Form

Patient Home Instructions:

• X-ray Use and Child Safety
• Soft Diet Instructions
• Preparing Your Child for Treatment
• Post Trauma Instructions
• Post-Extraction Instructions
• Pacifier Chart
• About Nitrous Oxide
• Toothbrush Calendar
• Flossing Chart
• About Canker Sores