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

X-Ray Release Form

When visiting our office, make sure to bring your original:
Driver’s License or Valid ID
Dental Insurance Card
Vaccination Card
Negative PCR Test taken within 72 hours PRIOR to your appointment if not vaccinated

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-3pm
Saturday: 8am-1pm

Contact
Our Office

(773) 643-6006 Request Appointment
Patient Name:

Read Our Hyde Park Dental News

Chicago Dentists

Best dentist Hyde Park

We Love Making You Smile | Best Dentist in Hyde Park

May 15th 2022

For most people, visiting the dentist isn’t exactly their idea of fun. Some people have a fear of going to the dentist and this keeps them from getting regular professional dental cleanings and essential oral health care. We understand how...

60615 dentist

7 Ways to Get Your Calcium Dairy-Free | Cosmetic Dentist in Hyde Park

May 1st 2022

Our dentist in 60615 agrees that calcium is an important mineral for building strong, healthy teeth, but not everyone can tolerate the lactose found in dairy. Lactose is a sugar found in milk and other dairy products. About 65% of...

60615 dentist

We’d Love to See You More | Preventive Dentist Hyde Park

April 15th 2022

Have you ever wondered how often you should be visiting our dentist in 60615? Being proactive rather than reactive with oral health could help prevent long term tooth loss and other dental problems.  According to a study published in the...