Patient Information
Dental Forms
For your convenience, we provide many of the forms you will need to complete as a new patient.
Download & Print
These forms are ready to download and print in PDF format so you can fill them out before coming in for your appointment. If you are a new patient, then please download the All Patient Form Kit.
If you are updating your information, you can download just those forms that you need.
Most computers can read this format, but if you are unable to you may need the Adobe PDF Reader.
| All Patient Forms Kit | |
| General Patient Information | |
| Insurance Billing Policy | |
| Medical History | |
| Dental History | |
| Notice of Privacy Practices | |
| Financial Policy | |
| Patient Records Release | |
| Sleep Scale |
For your convenience, we provide many of the forms you will need to complete as a new patient.
Financial
We accept all major credit cards (American Express, Discover, Mastercard and Visa), Apple Pay, Personal Checks, Cash and Care Credit.
Dental Care Insurance Membership Plan
No dental insurance? No problem! We offer an in-house dental membership plan to our patients to help save on their yearly preventative care. These dental plans include a children's dental plan (under 18), adult dental plan (over 18), and a periodontal dental plan. These dental plans also include a discount on any dental restorative work needed. For further information, please call our office at (630) 858-1232 and speak with Carrie and she will answer all your questions about it. It should take just a few minutes.
Dental Insurance
We accept all fee-for-service dental plans. Even though dental insurance is a private arrangement between you and your insurance company, we will file your claim, handle all of the paperwork and help you get maximum insurance benefits. Most insurers have websites. If you are unclear of your benefits, go to the company website and review your individual plans, or feel free to contact our Office Administrator. She will do what she can to find the answers to your questions.
