Below are our New Patient Forms. Click on the PDF form that you want to fill out to download it to your computer. Each document you fill out will better help us understand your medical history and make it easier to serve you with one of our many dentistry services. Bringing these forms filled out ahead of your first visit is optional, but it will allow us to assist you faster. If you have any questions about your appointment and these forms, feel free to call our office at 309-228-9575. We can’t wait to hear from you!

On the Authorization for the Disclosure of Healthcare Information, please write the name of the individual(s) you would like us to be able to speak to about your appointments, account and/or services.

AuthorizationPatient RegistrationAuthorizationAuthorization for Disclosure of Health InformationAuthorizationMedical History