Contact us for a Complimentary Consultation,

or call us at 312.704.5511

222 N. LaSalle, #230    Chicago, IL 60601

New Patient Registration Forms

Please click on the following links to download your registration forms. Once the files have downloaded, please print then out to bring with you upon your visit once you've filled them out. If you prefer to register online, please visit DentalAppointments.com or click on the image below.  As we are trying to "Go Green", we do encourage you to provide your e-mail address and register with DentalAppointments (link above). That way we can notify you of your upcoming appointments, communicate with you via email, send statements, etc. It also allows you the luxury of being able to view your history, make on-line payments, request an appointment and ask us questions, etc!!!

Make an Appointment 

Patient Registration Form

Medical History Form

Dental History Form