New Patient Forms

Dentist in Barrington

To provide you with the most efficient new patient experience, please download and complete the forms below and bring them to your first appointment.  Our team will take comprehensive records and address any concerns or questions you may have.   If you have any problems downloading the forms, please contact our office and we will gladly send them to you.

New Patient Forms

Your First Visit

Your first visit with us may include:

  • Comprehensive oral examination.
  • Full mouth digital x-rays.
  • Oral cancer screening.
  • Oral hygiene instruction.
  • Teeth cleaning.
  • One-on-one consultation with our dentist to discuss your needs, concerns, goals, and treatment options.

During your visit, we will answer any and all questions about your oral health. We will provide a detailed financial consultation to ensure your treatments are timed effectively and affordably.

Financial Arrangements

Payment is due at the time service is rendered, unless other arrangements have been made in advance.


Traditional insurance plans allow you to select your dentist of choice. For PPO and DMO insurance plans we are considered out of network.

Dental insurance can be a great health benefit to you; however, the amount your insurance does not cover is solely a reflection of the quantity of coverage your employer provides you and not a reflection of our office fees and policies. We ask for payment at the time services are rendered. We will generate a computerized claim form that you (or our office) can submit to your insurance company for reimbursement