Patient Forms

Chicago Family Dentists

To provide you with the most efficient new patient experience, please click the links below to complete and submit your forms electronically. If you have any problems submitting your forms, please contact our office.


New Patient Information
Health History
Notice of Privacy Practices HIPAA
Financial Policy
Patients Out of Network
Patient Photo Consent
ADA Patient Screening Form

When visiting our office, make sure to bring your original:
Driver’s License or Valid ID
Dental Insurance Card

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Visit Our
Chicago Office

Located in the historic
Hyde Park Bank Building

Hyde Park Family Dentist
1525 E. 53rd. St. Suite 734
Chicago, IL 60615

(773) 643–6006 |

Convenient
Office Hours

Monday: 8am-4pm
Tuesday: 8am-5pm
Wednesday: 8am-4pm
Thursday: 8am-5pm
Friday: 8am-2pm
Saturday: 8am-1pm

Contact
Our Office

(773) 643-6006 Request Appointment
Patient Name:

Read Our Hyde Park Dental News

Chicago Dentists

Filling in the Gaps: Your Options for Missing Teeth | Hyde Park Dentist

August 15th 2021

Are you embarrassed to show your smile because of missing teeth? For many people, missing teeth can create a feeling of diminished self-confidence. Modern dentistry can not only replace the gaps in your smile, our team can also create long-term...

4 Tips for Healthy, White Teeth | Dentist Near Me

August 1st 2021

Your smile is one of the first things that people notice about you. One way to make a lasting impression is to have a healthy-looking smile. Over the years, teeth whitening has become immensely popular. People turn to in-office whitening,...

VIDEO: Proven And Reliable Equipment to Get Consistent Clinical Outcomes | Dr. Louis Kaufman

July 20th 2021

Dr. Louis Kaufman recently appeared on Dental Voice on the Case with ZYRIS hosted by Rolando Mia.In this informative video, we get to see Dr. Kaufman in a teacher role and giving his advice on how important using proven systems...