Skip to main content
Dan Fong, DDS
(630) 620-7300
"Amazing Results"

   

 Stacy Foster-Office Manager



   Below are the forms you will need to complete and bring with you on your first visit with us.

All new patients will need the following forms: registration, medical, dental and financial policy form.

Please make sure you also bring your most current dental insurance card and photo id.

    Click here for NEW PATIENT REGISTRATION FORM-all patients

     Click here for MEDICAL FORM - ADULTS- 18 years and older 

     Click here for DENTAL FORM - ADULTS - 18 years and older

     Click here for CHILD MEDICAL/DENTAL FORM - 17 years and under

     Click here for FINANCIAL POLICY FORM - all patients    

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

   

 


845 S Main St
Suite 202
Lombard, IL 60148
(630) 620-7300 Main
(630)620-7352 Fax

 

 

Dan Fong, DDS    |    845 S Main St Suite 202, Lombard, IL 60148    |    (630) 620-7300