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

Upload Your Cards Here

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

Preventive Dentist in Hyde Park | Dental Implant Restorations

October 20th 2020

About 1 in 4 adults experience tooth loss between the ages of 21 and 30. Dental implants are a safe and long-term option for tooth replacement that improve the appearance and functionality of your smile. A dental implant can be...

Dentist in 60615 | Are Dental Veneers Right for Me?

October 6th 2020

We often have visitors to Smile Design Studio of Hyde Park ask about solutions for fixing stained teeth or filling in gaps between teeth. We sometimes suggest veneers. Veneers are one cosmetic option available for correcting your smile. Here’s what...

Dentist Hyde Park | You Need to Know About Oral Thrush: Here’s Why

September 16th 2020

Even a healthy mouth is lined with bacteria. Normally, your daily oral hygiene routine helps prevent oral health complications. However, it is possible to develop an excess of bacteria and fungi, which can lead to additional problems. Here’s what you...