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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

 

EXISTING PATIENTS

 

 

FORMS

 

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

 

 

 

WHAT TO BRING WITH YOU

 

  • 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.