Patient Resources

Park Ridge, IL Dentist

New Patient Forms

In order to provide you with the most efficient new patient experience, please download and complete the forms below and bring them to your first appointment. This will allow the new patient process to run quicker and smoother for both our dental practice and you.

We make sure to obtain important background information to include your medical and dental history. Our team will take comprehensive records and address any concerns or questions you may have.

Welcome To Our Practice
Health History
Notice of Privacy
Acknowledgement of Receipt

We Welcome New Patients

We are always accepting new patients of all ages. At your first visit, you will be welcomed by our friendly and inviting team. You will have the opportunity to meet with members of our dental team and get to know our Park Ridge periodontist. We are committed to educating you about your periodontic needs and will answer any questions you may have concerning your treatment.

We ensure to provide you with the highest level of periodontic care available today. Thank you for your confidence in our office and we look forward to meeting you.

Insurance and Billing

We can help to maximize your benefits. It is recommended that you contact our office prior to your appointment to provide us with insurance information for verification of benefits. If you have alternative dental insurance, we are more than happy to submit claims to your dental insurance company.

Financing Options

We accept checks, cash and credit cards.


Our center is pleased to present flexible payment plans through Lending Club Patient Solutions. With Lending Club Patient Solutions you may finance all of your treatment and related medications. Enjoy flexible plans with low fixed rates and monthly payments, no upfront payment, and no prepayment penalty. It’s easy to calculate your potential monthly payments. Simply complete a short application which displays fixed rates and monthly payments available for Extended Plans, all without impacting your credit score. For more information, simply ask a team member or visit

© 2015 Lending Club Patient Solutions products and services provided through Springstone Financial, LLC, a subsidiary of LendingClub Corporation. Payment plans made by issuing bank partners.