Patient Forms
Save Time Before Your Visit
Download and complete your forms at home so you can spend less time in the waiting room and more time focused on your care.
Please download, print, and complete the following forms before your appointment. Bring them with you on the day of your visit. If you have any questions, call us at (312) 263-7200.
Patient Information & Medical History
Contact info, demographics, medical conditions, medications, allergies, and dental history.
PDF
Insurance Information
Primary and secondary insurance provider and coverage details.
PDF
Financial Policy, Appointment Policy & Image Consent
Payment and appointment policies, plus consent for dental imaging.
PDF
HIPAA Notice of Privacy Practices
Our privacy practices and your rights as a patient.
PDF
Forms Ready? Schedule Your Visit
Book your appointment online or give us a call.