Patient Forms

Your first visit with Dentist R Us establishes a vital foundation for our relationship with you. During the first visit, we make sure to obtain important background information, like your medical history, and give you time to get to know your doctor.   If we do a follow up visit for fillings, we will require a Filling Permission Slip.  In addition, we can service your school every 6 months if they continue to participate in our program!   You can save time by printing out and completing the patient forms in advance of our 

Mission Statement
Our practice is working together to realize a shared vision of uncompromising excellence in dentistry.

To fulfill this mission, we are committed to:

• Listening to those we are privileged to serve.
• Earn the trust and respect of patients, profession and community.
• Exceed your expectations.
• Ensure a creative, challenging and compassionate professional environment.
• Strive for continuous improvement at all levels.

 

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Patient Forms

Please print and fill out these forms so we can expedite your first visit:

 

• HIPAA - Privacy Act
• General Information
• Michigan Forms
• Illinois Forms
  • IL Spanish Permission Slip
  • Il Permission Slip
• Indiana Forms

In order to view or print these forms you will need Adobe Acrobat Reader installed. Click here to download it.

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