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Hoffman Estates Dentist Provides Affordable Dentistry


The first step towards a beautiful, healthy smile is to schedule an appointment. Please contact our office by phone or complete an online appointment request.

Patient Forms

This section of our web site lists some of the most common forms that we use in our office. We have provided links to these forms in Adobe PDF format so you may view and print at your leisure. If you do not have Acrobat Reader you can download it free here. Please contact us with any questions you may have.

You can hand-carry filled out forms when you visit our our office or you can fax them to (847) 250-6979

  • New Patient - This form is completed by all new patients at their first visit and it allows us to get to know you better. If your first appointment is coming soon, print and complete this form prior to your first visit.
  • MD Clearance - We will send this form to your physician if we believe something in your medical history may have an impact on your dental treatment. If you may have an unresolved issue to resolve prior to your first visit, please contact us.
  • Records Request - People move all the time. If you have moved to a new location and would like us to send records to your new dentist, this form must be completed and sent to our office.

If you are a new patient to our office, please download our new patient bundle with forms that will need to be filled out when you arrive at our office. Printing them, filling them out and bringing them with you will allow us to attend to your medical needs more quickly than completing them on your arrival. Thank you and please contact our office if you have any questions at all.

Payment Options

For your convenience, we accept cash, personal checks, money orders, and most major credit cards. Payment is expected at the time services are performed. When more extensive dental care is necessary, financial arrangements can be made with our office.

Dental Insurance

As a service to our patients, our practice accepts most dental insurance programs, including non-managed care, indemnity (traditional) and PPO out-of-network. We are not part of any managed care network. Our accounting staff will prepare all the necessary forms for your dental benefits. However, we remind you that your specific policy is an agreement between you and your insurance company. Please keep in mind that you are responsible for your total obligation should your insurance benefits result in less coverage than anticipated. Our staff will gladly submit a pre-treatment estimate to your insurance company so that you will know what your benefits will be.

The fees charged for services rendered to those who are insured are the usual and customary fees charged to all our patients for similar services. Your policy may base its allowances on a fixed fee schedule, which may or may not coincide with our usual fees. You should be aware that different insurance companies vary greatly in the types of coverage available. Also, some companies take care of claims promptly while others delay payment for several months.

These documents are in Adobe PDF format. If you’re unable to read PDF files, please download free Adobe Acrobat Reader here.

Our Happy Patients

We're here to help you get the perfect smile!
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