chestnut-slide-2 copy

New Patient Information

Welcome to Glendale Heights Family Dental, where we are now open to new patients! We proudly welcome patients with and without insurance.

Save time by downloading your New Patient Forms and bringing your completed forms to your first appointment.

New Patient Forms

Download all new patient forms together below in a single PDF file.

Complete new patient packet

Download individual forms

Patient Information Form

Medical History Form

HIPAA Consent Form

Dental History Form

These pdf forms can be opened using Adobe Acrobat Reader. If you need a copy of this software click here, install Adobe Acrobat Reader now.

Have Any Questions?

  • If you have any questions about your first appointment or questions about your dental insurance, co-payment, deductible, or covered services, please call us at (630) 866 – 6000 or email us.