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

Dentist Hyde Park

Dentist in Hyde Park | Be Wary of These Beverages

April 7th 2021

It’s common knowledge that plenty of beverages are not good for your health. The excessive amounts of sugar, caffeine, or alcohol found in a lot of popular drinks have well-documented impacts on your body. However, you may not be aware...

Hyde Park dentist

60615 Dentist | 5 Teeth Sensitivity Myths

April 1st 2021

Do you suffer from regular sensitivity? Teeth sensitivity is often misunderstood, but our Hyde Park dentist can help you find relief. We’re here to separate fact from fiction in sensitivity. MYTH: People’s teeth are supposed to hurt when they bite...

Hyde Park IL Dentist | Ow! Your Guide to Canker Sores

March 15th 2021

A canker sore can make eating, drinking, and talking difficult and even painful. Maintaining your oral health by brushing and flossing may also be difficult with a sore in your mouth, but keeping up with your daily oral hygiene routine...