Patient Forms

Here at Treasured Smiles Adult and Cosmetic Dentistry, we understand that your time is valuable. For your convenience, you may download, print and fill out the following forms and bring them with you to your first appointment. If you would rather complete paperwork at our office, we ask that you arrive 15 minutes before your scheduled appointment.

HIPAA Notice Of Privacy Agreement

Financial Policy Agreement

Medical History

New Patient Form

Authorization To Share Health Information

How To View Forms

These forms require Adobe Acrobat Reader to view. If you do not have Adobe Reader already installed on your computer, click the Adobe logo to download.

Request An Appointment

Give the skilled team at Treasured Smiles Adult and Cosmetic Dentistry a call at (815)426-0016 and make an appointment for you or your family member. We have been helping our Frankfort, Mokena, and New Lenox, IL, neighbors maintain or regain excellent oral health for many years now. We look forward to helping you get the beautiful, healthy smile you deserve.