(309) 662-9042

 Patient Forms

For your convenience you can download our patient forms and bring them with you completed at your next appointment. Simply click on the links below to access them.

 

Patient Registration

Health History

Consent for Use and Disclosure

Acknowledgement of Receipt

Notice of Privacy Practices

Concierge Services

Accommodations for patients traveling from out of town for dental care can be made with:

Doubletree Hotel
Veteran’s Parkway and Brickyard Drive
Bloomington, IL 61701
(309) 664.6446