Dental Forms

For your initial appointment, please bring the completed and signed health history sheet available online and found in your information packet. Please bring any referral slips or x-rays as well. Lastly, if you will be using insurance coverage, please bring a completed and signed dental insurance claim form or a copy of your dental insurance card.


1105 W. Park Ave.
Libertyville, IL 60048
P: (847) 367-7150
F: (847) 362-5968

Monday 8:00am- 12pm and 1:00pm – 5:00pm
Thursday 9:00am- 6:00pm

Spring Grove
2020 Route 12
Spring Grove, IL 60081
P: (815) 675-0161
F: (815) 675-9943

Tuesday 9:00am- 6:00pm
Friday 8:00am-12:00pm and 1:00pm- 5:00pm