Affiliated Dental SpecialistsAffiliated Dental SpecialistsFor the Smile of a Lifetime

 

Patient Forms


Save time by downloading your New Patient Forms in PDF format and bringing your completed forms to your 1st appointment. Please note: there are several pages to download.

New Patient Forms
Adult Health History Adult Health History Form: Download 9Mb
Child Health History Child's Health History Form: Download 9Mb
Consent to Care Consent to Care Form: Download 4Mb
Insurance Form Insurance Form: Download 1.7Mb
 
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1 E. Phillip Rd #102 Vernon Hills, IL 60061 (847) 367-6055 | 36100 N. Brookside Dr #207 Gurnee, IL 60031 (847) 263-1801
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