• Phone Icon Westmont (630) 541-8374
  • Location Icon

    519 N Cass Ave, Suite 102, Westmont, IL 60559

  • Phone Icon Villa Park (630) 541-8374
  • Location Icon

    101 E. St. Charles Rd,Suite 101, Villa Park, IL 60181

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Patient Forms

Patient Forms

Please Complete Prior To Your Appointment

Please click on the following forms to print and bring to your first appointment. You may also complete the smile assessment (not required).

Patient Registration

Medical History

Smile Assessment

Your smile has a lot of effect on your overall self-confidence and social interaction. Lots of people are afraid of smiling or laughing. You can easily assess your smile by answering the following questions. Stand in front of the mirror, make a wide smile, and try asking yourself these questions:

  • If your answer to any of the above questions is YES, there are various solutions with which you can improve your smile and teeth. If you want us to personally respond to your smile analysis, please fill out the form below.

    You can finally possess the smile of your dream! Get in touch with us today to schedule a to schedule an appointment.


We Can’t Wait To Make You Smile!

Schedule Your Appointment Today!

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