If you need a more accessible version of this website, click this button on the right.Switch to Accessible Site

Smile Savers | Existing Patients in Chicago

Call Us Today! (773) 229-1050

General Dentistry For The Entire Family

7017 W. Archer Avenue
Chicago, IL. 60638







So we can provide you with the best possible care, we would like to confirm we have your information up-to-date.  Please complete the below questionnaires:


To complete and submit your patient forms ELECTRONICALLY, please use the links below:


        Health History Update Form

        Pre-Appointment Questionnaire



Otherwise, you can DOWNLOAD* and fill out all these forms and bring them with you to your appointment:

     1. Click on the link below to pen the form in a new tab

    2. Click on the "download" button to save the form to your computer

   3. Once downloaded, open each of the PDF documents in Adobe Reader, fill out, and print.


        Health History Update Form

        Pre-Appointment Questionnaire






  • A valid government issued ID

  • Your updated dental insurance card (if you have insurance)

  • Completed Health History Update Form and Pre-Appointment Questionnaire

  • Face mask or face covering


Chicago Dentist | Existing Patients. John Mrozek is a Chicago Dentist.