Online Patient Forms to Complete
Illinois Dental Consent FormIllinois Dental Consent Form (Spanish)Indiana Dental Consent FormIndiana Dental Consent Form (Spanish)Missouri Dental Consent FormMissouri 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 child's medical information can be used and our practice's non-discrimination and accessibility policies.
Notice of Privacy Practices (HIPAA)Non Discrimination Notice“This is a great opportunity for our students. The staff was great with kids and we only heard good things after their exams.”
– Ryan McClellan
Principal, Evansville Elem.
Looking for convenient pediatric dental services in Southern Illinois or Central Indiana area? Contact us at 618-993-8333 to schedule your child's appointment today!