Patient Forms

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Dental Patient Forms

This section of our web site lists some of the most common forms that we use in our office. We have provided links to these forms in Adobe PDF format so you may view and print at your leisure. If you do not have Acrobat Reader you can download it free here. Please contact us with any questions you may have.

You can hand-carry filled out forms when you visit our our office or you can fax them to (773) 482-3206

  • New Patient - This form is completed by all new patients at their first visit and it allows us to get to know you better. If your first appointment is coming soon, print and complete this form prior to your first visit.
  • MD Clearance - We will send this form to your physician if we believe something in your medical history may have an impact on your dental treatment. If you may have an unresolved issue to resolve prior to your first visit, please contact us.
  • Records Request - People move all the time. If you have moved to a new location and would like us to send records to your new dentist, this form must be completed and sent to our office.
  • If you are a new patient to our office, please download our new patient bundle with forms that will need to be filled out when you arrive at our office. Printing them, filling them out and bringing them with you will allow us to attend to your medical needs more quickly than completing them on your arrival. Thank you and please contact our office if you have any questions at all.

Our Happy Customers

"EDISON PARK DENTAL came as a recommendation from my wife's team at work, and boy did they deliver. EVERYONE was so energetic and eager to help. The front desk was extremely helpful. They had answers for all my questions. DENTAL HYGIENE staff was very helpful and extremely professional. Thank you! "

Chris T.

"It was my first visit at Edison Park Dental and I left there feeling amazing! The wait time was not long at all, I like how they text you confirming your appointment, everyone is really nice and helpful. I felt so comfortable! Their office is super clean. I will definitely be going back and would highly recommend others. "


"I've only been there once, but I plan on going back and making Edison Park Smiles my place to regularly make my dental appointments. Everyone is really nice, and everyone made me feel comfortable. They explained very well the procedures I need in order to have a healthier smile and the cost is reasonable!."

We're here to help you get the perfect smile!
Have Questions? Call Us Now (773) 482-3206  OR   Schedule Your Visit!
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With a Dental Certified Specialist