All new patients need to complete several important forms before their first appointment:
These forms provide us with essential information about your health history, insurance details, and treatment preferences.
We offer multiple ways to complete your patient forms
Online through our secure patient portal
In our office before your appointment (please arrive 15 minutes early)
Download and print forms from our website to complete ahead of time
Using our online portal is the most efficient option, allowing you to complete forms at your convenience from home.
Please inform us of any changes to your:
We recommend reviewing and updating your information annually or whenever significant changes occur to ensure we always have your most current information on file.
We take the privacy and security of your personal information seriously. All patient forms and records are maintained in accordance with HIPAA regulations. Our Notice of Privacy Practices explains how we may use and disclose your protected health information.
If you require assistance completing your forms due to language barriers or other special needs, please let us know in advance so we can arrange appropriate accommodations.
For patients under 18, a parent or legal guardian must complete and sign all forms. Please bring documentation of legal guardianship if applicable.
To process insurance claims efficiently, please provide:
Having complete insurance information helps us maximize your benefits and provide accurate cost estimates.
If you’ve been referred by another healthcare provider or need records transferred from a previous dentist, please inform us when scheduling your appointment. We have authorization forms available to facilitate this process.
Save time at your first visit by completing your patient forms before your appointment. Our front desk team is available to assist with any questions about our forms or documentation requirements.
Monday to Friday:
7 AM – 7 PM
Saturday:
8 AM – 1 PM
At Floss Lincoln Park Dental, we believe understanding your oral health should be simple and straightforward. Our dedicated team combines modern technology with personalized care to create a dental experience unlike any other in Chicago.
