East Village Dental Center in West Town Chicago.

First Visit

We understand that you have choices regarding dental care, Thank you for choosing East Village Dental Centre!

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During your first visit, we will gather all your necessary information. This includes a thorough review of your medical history. You can download the Medical History Form and bring it with you, email it to us at eastvillagedental@gmail.com, or you can fax (773-252-1107) it to us.

If you require assistance in verifying your insurance please call our staff at 773-278-6622 and we will be happy to assist you.


ENGLISH HEALTH HISTORY FORM

Our patient forms are available for you to print and fill out prior to your appointment. Please bring forms and dental insurance cards with you. Thank you.

DOWNLOAD FORM HERE

FORMULARIO DE HISTORIA DE LA SALUD EN ESPAÑOL
Nuestros formularios de los pacientes se encuentran disponibles para que usted pueda imprimir y llenar antes de su cita. Favor de traer los formularios y tarjetas de seguro dental con usted. Gracias.

DESCARGUE AQUÍ EL FORMULARIO

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