Serving Streamwood, IL and the Surrounding Areas | 630-837-0887


Dental Form

Fill Out Your Dental Forms Online Right Now

In order to provide you with optimal dental care and customer service, we must ask for your assistance and cooperation by providing us with your information. We want our relationship to start off on the right foot and eliminate the feeling of being rushed. The truth is no one enjoys filling out forms, and even less when they feel like they’re being watched in the reception room. In this day and age of online efficiency, you have the opportunity to take care of the paperwork in the convenience of your own home.

Expedite the Paperwork by Doing It Online

Download your forms online beforehand to eliminate a great deal of the waiting time. All of our forms are secure and HIPAA compliant. You can fill out these forms anytime, day or night, before you come in. Get the VIP treatment as one of our preapproved clients. You can print out the forms and bring them to the office for faster services.

Find the Relevant Form for Your Specific Purpose

Writing on a paper

We Guarantee Confidentiality, Safety, and Security

New Image Dental makes it a point to follow and exceed all federal and state requirements regarding the safety, confidentiality, and security of patient files. This is required by law under the Health Insurance Portability & Accountability Act of 1996 (HIPAA) and the modifications made under HITECH / ARRA Act (effective as of 3/26/13).
All health care records and other individually identifiable health information used or disclosed to us in any forms, whether electronically, on paper, or orally, will be kept confidential. Federal and state laws give you, the patient, significant new rights to understand and control how your health information is used.

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Visit us for EMERGENCY dental care!

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