New Patient Forms

Information entered on this site, emailed or faxed is secure and only accessible by authorized personnel in the office.

You have three options for submitting the four New Patient Forms (Medical History, Consent (HIPPA), Early TMJ Detection, Insurance and Cancellation Policy) below:

1. Open the Adobe Acrobat document, print and fill it out and bring it with you to your appointment,
2. print and fill it out and then fax it to us at 312-332-4423,
3. open the Microsoft Word document, fill it out, download it and then e-mail it to the office.

New Patients Forms: Medical History, Consent (HIPPA), Early TMJ Detection, Insurance and Cancellation Policy

New patients to the practice may fill out the below forms ahead of time.

 Complete Set of New Patient Forms (158 KB)
You can type directly into this form and print it.

Dental Records Transfer Form

If you are transferring to Dr. Beaty, Blaine or Sahgal from another dentist, it is your responsibility to have your dental records and radiographs sent to our office before your first visit or you may also wish to bring them along with you. If you need a form to request the transferring of your records, you can fill out the form below.