New Patient Information

For your convenience our Pediatric Dental office has provided the forms to be completed at the first visit. Feel free to print out the forms at home and complete them prior to your initial visit.

Health History

Dental Insurance Information

Consent for Treatment & Financial Responsibility

School Dental Form

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.  We have included a link to this form above.