Arlington Heights Dentist - Patient Forms

Call us : 847-253-8501
Accepting New Patients

201 N. Arlington Heights Rd
Arlington Heights, IL 60004

Driving Directions

Testimonials

From Terrence O. of Arlington Heights: Quality, High Tech Care, with a visionary plan for every patient.  All in an efficien....

Terrance O. -

From Julie A. of Arlington Heights: Great office, great staff, great dentists.  I would highly recommend them.  Everyth....

Julie A. -

From Janet M. of Algonquin: I am always extremely satisfied with my visit experiences.  In all areas of this dental practice....

Janet M. -

Office Hours

Monday8:00AM-6:00PM
Tuesday8:00AM-6:00PM
Wednesday7:00AM-5:00PM
Thursday8:00AM-5:00PM
Friday8:00AM-5:00PM
Saturday8:00AM-2:00PM
Sundayclosed

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Patient Forms

FORMS

You can save time by printing out these froms and filling them in for your first visit - thank you! We look forward to getting to know you and helping you create the smile you've always dreamed of!

 

1. Patient Information Form
Patient Information

2. Patient Medical History Form
Medical History

3. Acknowledgment Receipt Form
Acknowledgment Receipt

4. Notice of Privacy
Privacy