All forms needing to be filled out prior to your appointment will be included in our initial email or text message correspondence after scheduling your appointment. Please keep any eye out for that link!
For your convenience and in order to help ensure a successful visit, our office has made it easy for you to complete all forms online. Please be sure to complete them prior to your appointment to help avoid any delays. (Below are links for each form and a guide to understanding which forms should be completed.)
Medical History– must be completed for new patients and updated every 2 YEARS for current patients (think of the last two years when answering the questions)
Insurance Information– to be completed for new patients OR current patients with recent changes/updates to their dental insurance
HIPAA/Financial – must be completed for new patients or by current patients at age 18 click here to view our Notice of Privacy Practices
Contact Information– to be completed for new patients or current patients with changes to their address, phone numbers, and/or email address
Children entering Kindergarten, 2nd grade, 6th grade, and 9th grade are required by the state of Illinois to have proof of a dental examination on file with their school. Please email us at office@pediatricdentistns.com if you are in need of an update form.
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