Show menu

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.

Our Blogs

Getting Rid of Your Bad Breath

Hygienist's Corner

New Patient? How to transfer your records

Blog

3 Facts About Dental Insuranceinsurance-blog

Front Desk

Save Money On Your Dental Bill

Front Desk

Oral Health and Nutrition

Hygienist's Corner

Health Risks Related to Peridontal Disease

Hygienist's Corner

Fluoride

Hygienist's Corner

Why Baby Teeth are Important

Hygienist's Corner

Guards Plus

Hygienist's Corner

Make An Appointment

Our office isĀ open:
Mondays: 9am to 5pm
Tuesdays: 12:30pm to 7pm
Thursdays: 8am to 4pm
Fridays: By Appointment

Meet Our Doctor

Dr. Robin Jungblut

Get to know Dr. Jungblut.
Click here to read more...

Out Pages

Our Locations

Glen Ellyn Smiles
493 Duane St., Suite 103
Glen Ellyn, IL 60137
Phone: (630) 858-1232
Fax: (630) 858-1299

Our Hours

Mondays: 9am to 5pm
Tuesdays: 12:30pm to 7pm
Thursdays: 8am to 4pm
Fridays: By Appointment Only