Patient Registration

You may preregister with our office by filling out our secure online Patient Registration Form. After you have completed the form, please make sure to press the Submit button at the bottom to automatically send us your information. The security and privacy of your personal data is one of our primary concerns and we have taken every precaution to protect it.

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Click here to Register Online.

Patient Forms

You may also download and print our office forms.  Complete and bring with you on your next appointment.

Please call us at Mount Prospect Dentist Office Phone Number 847-255-5550 if you have any questions about completing our registration forms.

We’re Here To Help!

Call our caring staff with any questions or concerns!

Call us: 847-255-5550