If you are a new patient to our office, please print and fill out the necessary forms below and bring them with you to your first visit with us. This will expedite the registration process.

Health History Form

Insurance Information

Office Insurance Policy

Acknowledgement of Receipt of Notice of Privacy Practices

HIPAA Consent to Leave a Message

Our Office
Crystal Lake Endodontics
610 Crystal Point Drive, Suite 6
Crystal Lake, IL 60014
Phone: (815) 455-9155
Fax: (815) 455-3603