New Patient Forms

We are happy to offer our patient forms online. Please feel free to print and fill them out at your convenience before your visit.

New Patient Registration

Please download, print and complete this form before your first dental appointment.
Click here to download (1.1 MB)

Notice of Privacy Practices

Please read this document before your first dental appointment.
Click here to download (683 KB)

Notice of Privacy Practices Receipt

Please download, print and complete this form before your first dental appointment. This form confirms that you read our Notice of Privacy Practices.
Click here to download (500 KB)

Payment Policy

Please download, print and complete this form before your first dental appointment.
Click here to download (533 KB)

 
If you are unable to view the pdf files, please click on the icon below to download and install Adobe Reader:

$55 New Patient Special

This adult special includes an exam, x-rays, cleaning (certain limitations may apply), oral health screening, consultation, and take-home care it. Call for an appointment today and mention this special.

View More Special Offers

Our Office

Prairie Meadow Dental

2323 Randall Road
Carpentersville, IL 60110
Map & Directions
 
Phone: 847-426-6520
 

Office Hours:
Monday8:00am-2:00pm
Tuesday 12:00pm-7:00pm
Thursday12:00pm-6:00pm
Friday*12:00pm-6:00pm
Saturday** 8:00am-1:00pm


* 3 per month
** 2 per month