New & Existing Patient Forms

For our new patients, please download all of the forms found in the “New Patient Forms” section. Please bring these forms with you to your appointment. We have also included several of our most common forms for you to review prior to your visits.

New Patient Forms

• Demographic / Health History
• Request and Consent for Pediatric Dental Treatment
• HIPAA
• Appointment Policies
• Financial Policies
• Behavior Management Techniques

General information

• "Sleepy Juice" Information (anesthesia/numbness)
• Post-extraction Information
• Appliance Information
• Sedation Information
• Sedation Consent
• Parent Satisfaction
• Special Needs Questionaire
• Papoose Consent
• Nitrous Oxide Consent
• Non-parent Consent Form (for nannies, babysitters or other family member/friends bringing children to appointments)

Click here to Make an Appointment or call us today.
Chicago Office: 773.772.7373  or Hoffman Estates: 847.882.2555