Patient Information Forms

Dental Patients 

Please print each form out and either bring the completed forms with you to your appointment or email them to us at If you have any trouble with the documents please do not hesitate to call.

Sleep Apnea Patients

Please click on the questionnaire link below and complete the prompts.

Sleep Apnea Questionnaire

Contact Us

We encourage you to contact us with any questions or comments you may have. Please call our office or use the quick contact form below.

Office Location

  • Poplar Grove
  • 13510 Julie Drive
  • Poplar Grove, Illinois
  • 61065
  • Map & Directions
  • Call: (815) 765-9900