Call: 815-384-2494

New Patient Forms and Information

For your convenience, please PRINT and COMPLETE the appropriate forms from the provided links on this page and BRING them with you to your first appointment. 

Adult (18 yrs and older) Forms

Young Adult (12-17 yrs)  Forms

Child (up to 12 yrs)  Forms


Your First Visit

Excellence in dentistry begins with a careful diagnosis and a treatment plan to move us toward the goals we will establish together.  Adult new patients are generally scheduled for an initial examination with the doctor, which will include a review of hard and soft tissues of your mouth.  A complete set of digital xrays, a panaoramic xray and a series of intraoral photographs will be taken on each new patient to ensure proper diagnosis.  In some circumstances, a patient may be asked to return for a "review of findings" consultation.

Younger patients will be seen by one of our doctors, as well as the hygienist, and will receive a prophylaxis (dental cleaning) at the first appointment.  We encourage parents to bring their children in for their first examination between two and three years of age.


 Office Policies

Account Responsibility

 When a patient is registered at our office, the patient accepts final responsibility for payment.  Patients without dental insurance are expected to pay for their visits at the time of service.   Patients with dental insurance are expected to pay their non-insurance portions and any deductible at the time of service.  As a courtesy to our patients, we will assist in the submission of all primary dental insurance claims.  All non-insurance portions, deductibles, and secondary insurance portions will be collected at the time of service.  We accept cash, check, money order, or major credit cards (Visa, Mastercard, Discover).  We do not participate in any "managed care" insurance plans.  Your PPO insurance may allow out of network treatment at a lower reimbursement rate.  It is the patients' responsibility to be aware of their dental insurance benefits and coverage. 


Cancellation/No Show Policy

 The office kindly requests 48 hours notice prior to cancellation of appointments.  Because time has been reserved specifically for you, we reserve the right to assess a fee for appointments canceled without sufficient notice.  Confirmation calls are made by our office prior to patient's appointment in order to verify our schedule.  It is the patients' responsibility to be aware of their appointment date and time.



 We offer Care Credit and Lending Club for patient financing.  This company can help to make your treatment affordable with convenient payment plans ranging from 6 to 24 months (extended terms also available).


Contact us today at 815-384-2494 or via e-mail at