Please check every box on this form, even if the answer is “N/A” (not applicable). This information will be kept in the strictest confidence.
You also should know that changes in other parts of your body may affect the oral cavity and what dental treatment can be done, even if they seem unconnected. Cardiac (heart) problems, artificial joints and diabetes are just some examples.
355 S Greenleaf Ave, Ste E, Park City, IL 60085
Mon and Fri: 9am-7pm Tue: 9am-2pm
Wed and Thu: 9am-5pm Sat: 9am-1pm Sun: Closed
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