Patient Forms in Lansing, IL


Please click the image below to download. Once finished, please print and complete the required Health History & Registration Form.

Form #1


Form #2

*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.

Existing Patients:

Please download, then print and complete the same form if it has been more than 3 years since your last visit to our office.

State of Illinois Child Dental Exam form:

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.
Should you need this form and do not have it, feel free to print, then complete the parental information & bring with you to your child's appointment.

The State of Illinois form can be easily downloaded here.