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Downloadable Forms

Telephone: 312-750-9000

Hours by Appointment, Only
(312) 750-9000

Dentistry at Millennium Park, Chicago
8 South Michigan Avenue, Suite 1800
Chicago, Illinois 60603

Map and Directions

1) Bonding Instructions

2) Bleaching Post Care Instructions

3) Bleaching Maintenance / Home Bleaching

4) PerioProtect Information

5) Tooth Preparation (Crown / Onlay)

6) Cementation (Crown / Onlay)

7) Informed Consent for Dental Ozone

8) Snore Guard Information

9) Nitrous Oxide (Laughing Gas)

10) Root Canal Treatment Information

11) Lumineer / Laminate Information

12 ) GUARANTEE INFORMATION

13) Information about a Healthy Mouth

14) Information on the Oral-Systemic Link

New Patients: Please Click-on and print the information below and bring to your first appointment: Thank you. PLEASE NOTE: These forms take time to download.

Welcome Letter and Dental Practice Technology Information
Privacy Practices and Important Information - 4 pages

4 Page Initial Record / Health History
Consent for use and disclosure of Health Information
Acknowledgement Receipt of Privacy Practices