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Patient Forms

 
(708) 873-9074

If you're a new client, please complete the following form and bring it to your first visit to our dentist office. This will ensure you to have the maximum amount of time with the doctor.

New Patient Form 
Agreement to Pay for Treatment Form 
Medical History Form 
Privacy Practices Acknowledgement

If you would like us to coordinate with another dental clinic to request x-rays, please complete this form:

X-Ray Release Form 
HIPAA Authorization Form

 

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