New Patient Forms

For your convenience, we’ve provided our patient forms online. Completing these forms before your visit can help streamline your check-in process and reduce wait times.

Please download, print, and complete the necessary forms before your appointment. If you have any questions, feel free to contact our office for assistance.

Adult

Adult Dental History
Adult Medical History
Adult Patient Registration

Pediatric

Pediatric Medical History
Pediatric Patient Registration

You may return completed forms by bringing them to your appointment. If you need assistance or are unsure which forms to complete, please call our office at Halkyard Family Dental Phone Number (815) 942-0830. We’re happy to help!

Patient Registration Forms