All patients need the following forms on file in our office. New patients should print and complete copies of these forms and bring them to their first appointment:
Online Health History Form
New Patient Registration Form
(PDF)
Customer Service Registration
(PDF)
New Patient Financial Arrangement Form
(PDF)
If you want us to know specific fears and concerns you have regarding dentistry, please complete this additional form:
Dental Anxiety Questionnaire
(PDF)
Patricia A. Gilleran, D.D.S.
Amy M. Van Fossen, D.D.S.
25 E. Washington, Suite 1101 | Chicago, IL 60602 | 312-368-8771
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