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

Authorization to Release All Dental Records Form
Sleep Disorders

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

Read Our Hyde Park Dental News

Chicago Dentists

60615 Dentist

Are Your Drinks Attacking Your Teeth? | 60615 Dentist

January 15th 2023

If carbonated soft drinks are part of your normal daily routine, you may be causing serious damage to your teeth. Recent studies have found soft drinks to be among the most potent dietary causes of tooth decay. Soft drinks have...

Hyde Park Dentist

6 Tips for Preventing Tooth Decay in Children | Hyde Park Dentist

January 1st 2023

Oral health is important at every stage in life. Just because your children are going to lose their primary (baby) teeth eventually doesn’t mean that we can ignore the importance of dental care. Tooth decay can be painful and uncomfortable...

Preventive Dentist Hyde Park

Periodontal Disease and Rheumatoid Arthritis | Preventive Dentist Hyde Park

December 15th 2022

Periodontal disease, or gum disease, and Rheumatoid Arthritis (RA) are a systemic inflammatory disorder, which is how they have a connection. Both diseases frustrate the immune system and attack its own tissues, eventually leading to tooth loss and pain of...


Hyde Park Dentist