Online Patient Registration

Patient forms decorative image

For your convenience, please click on the appropriate button below to complete and submit the Online Dental Form prior to your child's visit with Dental Safari Company.

Online Patient Forms to Complete

Illinois Dental Consent Form
Illinois Dental Consent Form (Spanish)
Indiana Dental Consent Form
Indiana Dental Consent Form (Spanish)

Patient PDF Forms to Review

Please click on the buttons below to review our compliance with HIPAA rules surrounding how your medical information can be used and non-discrimination and accessibility.

Notice of Privacy Practices (HIPAA)
Non Discrimination Notice