Information Request

Your health is important to us, and we know it is to you as well. If you have additional questions, please complete and submit the request form below. One of our office staff will contact you soon to assist you with your concerns. 

If you have a question about an existing appointment, or if you require immediate attention, please call our office directly at 847-884-0125.  *Please do not use this form to request an appointment.  We will happy to schedule you over the phone.*

Contact information:

Bold fields are required.

Please provide the name of the dentist or patient who referred you.

Contact preferences:

What is the best day to reach you?

When is the best time to reach you?

Back to Top