We look forward to meeting you at your appointment! Welcome to our dental office!

dental patient forms

  • New Patient Information Form
  • Health History Form 1/2
  • Health History Form 2/2
  • Insurance Information Form


  • As your Evanston dental health provider…

    • When you need us, we will do our best to always be there for you.
    • Your concerns are our priority and we promise to listen and address your questions.
    • Your dental health goals define the most appropriate services you receive.
    • Your identity will always be protected. As such, we follow strict HIPPA guidelines to insure that you’re health information is safe and confidential.
    • With mutual respect and trust, together we will develop the best dental plan.
    • Your dental experience should be an educational one that leads to prevention. Many serious dental conditions can be avoided with regular check-ups and good home care.
    • You will discover superior service that improves the qualify of your life and of your family through state-of-the-art dentistry.

    We thank you for placing trust in us. We appreciate the confidence you show us when you refer your family and friends.

    “It’s about your health. Healthy Teeth. Healthy Body.”

    Your comfort, both dental and financial, is important to us and we will make every effort to work with you toward that end. If at any time you have questions regarding treatment or service fees, feel free to discuss your concerns with us. We can be reached at 847-475-4080 or via email at chernoffdentist@gmail.com. We recognize the value of your time. Except in emergency situations, you can expect us to be on time for you. We would appreciate the same courtesy. It’s our hope that we can give you plenty to smile about!

    We look forward to seeing you at your appointment!

    New patients may save time at their first appointment by filling out basic information, health history, and insurance forms prior to their first visit. Please click the above links to download and print these forms, fill them out, and bring them to your first appointment.

    Please download Adobe Acrobat below to view/print forms.