Health History Package

Before your first visit, please fill out the form below so that your check-in for your appointment is quicker and easier!

Adult Health History Package

Child Health History Package

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Contact Us Today

East Village Dental Centre

901 N. Ashland Ave.
Chicago, IL 60622

(773) 278-6622

Office Hours

Mon, Tues, Thu8am – 7pm
Wed, Fri8am – 2pm
Saturday8am – 2pm
Sundayclosed