In preparation for your child’s dental appointments, we have the following office forms available to download in PDF format to print from your home computer. Please complete the paper forms at home and either bring them with you at your appointment time or fax to us at 630-858-6204.
Illinois Department of Public Health Proof of School Dental Examination Form
The State of Illinois has a new form that is mandatory for children entering kindergarten, second grade, sixth grade, or when they are changing schools. You can download the form here, fill it out and mail or fax it to us. You can also fill out the form online here.
Patient Registration
This is a health history form. Please complete one for each child.
Family Registration
This form asks for parents’ names, addresses and dental insurance registration. Please complete one form for each family unit. Established patients can use this form to provide updates and changes to their family data on file.
Financial Policy
As we anticipate a good long-term relationship with our families, we present our financial policy. Please read this carefully, sign it and return to our office.
Health Information Privacy Policy – HIPPA
Stating how we handle personal health information, we ask you to read this carefully, sign it and return to our office.
