Call: (217) 359-3925

Patient Forms

If you are a new patient to our Champaign dental office, the forms below can be filled out before you arrive for your first appointment. Printing the forms, filling them out and bringing them with you will allow us to attend to your dental needs more quickly than completing them upon your arrival.  Thank you and please call our us if you have any questions or need any assistance. 


New Patient Registration Form

Patient Consent Form

Medical History

HIPPA Patient Consent Form

Financial Policy


This web site uses files in Adobe Acrobat Portable Document Format (pdf) which require Adobe® Acrobat® Reader for viewing and printing. It is available to download free.



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