We are incredibly excited to announce that we have reopened. Our number one priority is to ensure your safety and well-being. In addition to following universal infection control and strict sanitization protocols, we have added several new protective measures to keep both you and our staff safe and comfortable. We can't wait to see all our current patients and are currently welcoming new patients as well.

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773.382.1771

2112 N Clybourn Ave, Unit B, Chicago, IL 60614

Patient Forms

PATIENT FORMS

PATIENT FORMS

 

Please take a moment to fill out the appropriate form below prior to your first visit. Having the information ready when you arrive will help make your consultation proceed as smoothly as possible. Please also plan to bring with you or have your dentist email us a panoramic X-ray dated within the past 6 months (if you have one) in order to reduce repetitive radiation.

New Patient Intake
Child (Under Age 18)

 

New Patient Intake
Adult (Age 18 or Older)