Patient Registration

Photo of a patient filling in their Medical History on a Patient Registration form You may preregister with our office by printing our Patient Registration form (available below). This form is two pages long; please be sure to fill out the Medical History portion as completely as possible. After you have completed your Patient Registration form, please make sure to bring it with you at the time of your appointment.

Patient Registration Form

Technical Note

This form is in PDF format. If you are unable to open and print our Patient Registration form, you may download and install Adobe Acrobat Reader for free to help you. We are also available in the office, if you have questions: Chicago Endontist Office Phone Number 773-792-2369.

Office Hours

Monday:   10:00 AM - 5:00 PM
Tuesday:   10:00 AM - 7:00 PM
Wednesday:   10:00 AM - 5:00 PM
Thursday:   9:00 AM - 3:00 PM
Friday:   9:00 AM - 4:00 PM
Saturday:   8:00 AM - 1:00 PM
Sunday:   Closed

Schedule Your Appointment Today

Call us: 773-792-2369