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

Please click on, download and fill out these Registration Forms below:

1) Patient Record - 4 pages 

2) Consent for use and disclosure of Health Information (HIPAA)

3) Acknowledgement Receipt of Privacy Practices 

Telephone: (312) 750-9000 New Patients: Please click on 3 Blue forms at the BELOW

Hours by Appointment, Only
(312) 750-9000

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

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