Patient Forms

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Patient Forms 2017-08-23T21:23:33+00:00

Please complete and bring the following forms to your child’s first visit:

We look forward to meeting you and your child! Feel free to bring a favorite CD or DVD!

State of Illinois Proof of School Dental Examination Form

  • School Dental Exam Form – This form is required by Illinois State Law for Kindergarten, second, and sixth grade students.  We are happy to complete this form for you.

Referral Form for Referring Doctors