*Windows users: Should you have any problems downloading this form you can alternatively click here to view this form, then right click for option to print.
Please arrive to your appointment about 15 minutes early allowing adequate time to register your paperwork with the front desk receptionist.
Important: Persons responsible for account must bring their current Drivers License, or valid State issued ID, to the appointment in order to complete the registration process.
, then print and complete the same form if it has been more than 3 years since your last visit to our office.
If your child's goes to school in Illinois, then he or she is likely required to have this “State of Illinois, Department of Public Health Proof of Dental Examination Form” filled out after their exam.