New Patient Information

about-2University Dental Associates (UDA) offers premier dental services in six convenient Chicagoland locations.

Our professional goals include:

  • Offering our patients an open dialogue with doctors and consistent communication.
  • Exceed our patients’ expectations each and every time.
  • Maintain a creative, challenging, compassionate, and professional environment.
  • Ongoing training in the advancement of dental procedures by our doctors and staff.

New Patient Forms

Please print out and complete the New Patient Forms prior to your visit.

Patient Information Form

Dental History Form

Health History (Part 1)

Health History (Part 2)

HIPPA Concent Form

Financial Policy

Cancellation & Record Release Form

Submit the form below to request your appointment today!

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