Hoffman Estates: 847.882.2555    Lemont: 630.243.6200

New & Existing Patient Forms

Please complete the Demographic/Health Form and read the Appointment Policy, Financial Policy, Request and Consent for Pediatric Dental Treatment Form, HIPAA Policy, and Patient Management Techniques Form.

After reading all of the forms, please initial and sign the New Patient Forms Checklist. Please bring the completed Demographic/Health Form and the New Patient Forms Checklist to your child's appointment.

New Patient Forms

General information

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Hoffman Estates: 847.882.2555 or Lemont: 630-243-6200