Patient Forms

Here are the forms that you can complete before you come to our office for the first time:

Registration Form
Registration Form.pdf
Adobe Acrobat document [62.0 KB]

Medical History Form
MedicalHistoryForm.pdf
Adobe Acrobat document [45.7 KB]

Skokie HIPAA Privacy Consent Form
Skokie HIPAA Form.pdf
Adobe Acrobat document [219.3 KB]

Gurnee HIPAA Privacy Consent Form
Gurnee HIPAA Form.pdf
Adobe Acrobat document [143.0 KB]

HIPAA Notice of Privacy Practices
NOTICE OF PRIVACY PRACTICES.pdf
Adobe Acrobat document [11.7 KB]

Here are the forms that you can complete before you come to our office for sleep screening:

Sleep Questionnaires
sleep questionnaire.pdf
Adobe Acrobat document [1.3 MB]

Contact Us Today!

Northshore Metropolitan Dental Associates

Skokie Location

4709 Golf Road

Suite 804
Skokie, IL 60076

Phone: +1 847 673-6770+1 847 673-6770

Email:

skokie@nsmetrodental.com

Gurnee Location

1790 Nations Drive

Suite 212
Gurnee, IL 60031

Phone: +1 847 336-4880

Email:

gurnee@nsmetrodental.com

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