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PATIENT FORMS
Forms
After scheduling your initial appointment you will be receiving a text and email from Cuadros Dental allowing you to complete your intake forms prior to your appointment.

If you are unable to complete those forms, please arrive 20 minutes early to your appointment to complete them in-person. Thank you!

PRINTABLE VERSIONS OF NEW PATIENT FORMS:
HIPAA SIGNATURE PAGE TO PRINT
HIPPA DOCUMENT
PATIENT INFORMATION DOCUMENT
MEDICAL HISTORY DOCUMENT
Some of the plans we accept include...

  • Aetna
  • Cigna
  • Delta Dental
  • Blue Cross/Blue Shield
  • Dentemax
  • Guardian
  • Met Life
  • Principal Insurance
  • Humana
  • United Healthcare
  • Self-Pay
COVID-19 NOTICE: As a medical facility committed to the health of our patients, staff, and community, we have all the CDC, Illinois Department of Public Health, Illinois State Dental Society guidelines strictly enforced to ensure your comfort as we safely navigate the COVID-19 pandemic.