Orthodontic Patient Forms

We’re look forward to meeting you at your first visit to our Vernon Hills & Gurnee, IL orthodontic offices. At your first visit, our friendly front-office staff will help you get acquainted with our offices and answer any questions that you might have. Whether you are interested in adult braces or Invisalign, or are bringing your child in for a consultation, our Libertyville orthodontists are committed to providing the highest quality orthodontic care in a welcoming and comfortable environment.

For your convenience, our new patient forms are posted for you below. You can save time by filling them out before you come in and bringing them with you to your first visit.

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
Insurance Form Privacy Practices: Download 205Kb

 

Contact Our Gurnee & Vernon Hills Orthodontic Offices

If you have any questions about your first visit or the new patient forms, please don’t hesitate to contact us. Affiliated Dental Specialists proudly serves patients of all ages from Gurnee, Vernon Hills, Libertyville, Grayslake and Lindenhurst, IL as well as the surrounding communities. Dr. Port and Dr. Klein are always happy to meet new patients and welcome you to the AFFDS family. We look forward to meeting you!