Online Patient Registration

Patient Forms for Family Dentist in Lombard IL

You may preregister with our office by filling out our secure online Patient Registration Form. After you have completed the form, please make sure to press the Submit button at the bottom to automatically send us your information. On your first visit to our office, we will have your completed form available for your signature. The security and privacy of your personal data is one of our primary concerns and we have taken every precaution to protect it.

Submit Patient Information Below:


Office Hours

Monday through Tuesday:   8:30am - 5pm
Wednesday:   Closed
Thursday:   8:30am - 5pm
Friday:   8am - 2pm
Saturday:   8am - 2pmOncepermonth
Sunday:   Closed

Online Map & Driving Directions

If this is the first time you have visited our Lombard office, the mapping service below will assist you in finding our location. Simply fill out the form below, and you will be presented with directions that include a map, the travel time, and distance. If you need any additional information, please contact us at Lombard IL Cosmetic Dentistry Office Phone Number 630-627-1495.

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