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Patient Information
Your First Visit
Please assist us at the time of your
initial visit to the office by providing the following
information:
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Your referral slip and x-rays
from your referring dentist.
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A list of medications you are currently taking.
Please note that you can fill out your patient
registration (both sides) and medical history form
on this web page. Click here to down load...Front
Side and
Back Side
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If you have dental insurance,
please bring any forms or insurance cards with you
to the appointment.
Please Note: All
patients under 18 must be accompanied by a parent or
guardian at the consultation appointment.
Please notify the office if you have
a medical condition or concern prior to surgery (e.g.
artificial heart valves or joints, heart murmurs
requiring pre-medication, severe diabetes, or
hypertension.)
If your referring dentist has taken
x-rays, you may request that they be forwarded to us.
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David C. McClenahan, D.D.S., North Suburban Periodontics, Ltd.
755 S. Milwaukee Ave, Suite 120, Libertyville, IL 60048, Phone:
847 362-6650, Fax: 847 362-7902
711 North McKinley Rd, Lake Forest, IL 60045, Phone: 847
234-0600, Fax: 847 234-0163
e-Mail: NSP755@sbcglobal.net
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Libertyville: 847 362-6650
