Patient Forms | Loukas Dentistry Park Ridge, IL
Patient Forms — Loukas Dentistry, Park Ridge, IL
Your first appointment runs more smoothly when paperwork is done beforehand. Complete your patient forms at home and bring them to your appointment, or arrive 15 minutes early to fill them out in our office. All forms are confidential and used to provide you with safe, personalized dental care.
Why We Need Your Health History
Your medical and dental history directly affects how we treat you. Certain medications—blood thinners, bisphosphonates, immunosuppressants, and others—change how your mouth heals, how much you bleed during treatment, and what procedures are safe for you. Allergies to medications or materials (especially latex and epoxy-based acrylics in dentures) must be documented before we start work.
If you’ve had bad reactions to anesthesia, had difficulty with sedation, or have a heart condition, pacemaker, or implant, we need to know before your appointment. The same goes for pregnancy, bleeding disorders, or medications that affect healing. These details don’t disqualify you from treatment—they just mean we adjust our approach.
What Forms You’ll Complete
New Patient Registration Form
This form collects your personal information, contact details, emergency contact, and refers you to our insurance and consent sections. It takes 3–5 minutes and helps us reach you with appointment reminders or results.
Medical and Dental History Questionnaire
We ask about current medications (including supplements), past dental work, your experience with anesthesia, anxiety about dentistry, previous bad reactions, and medical conditions. Be thorough and honest—this protects you and makes your treatment safer and more predictable.
Insurance Information Card
Bring your insurance card or provide the details in writing so we can verify your benefits before your first appointment. We’ll check your deductible, annual maximum, coverage limits, and any waiting periods. See our financing and insurance page for details on what we accept.
HIPAA and Consent Forms
We explain how your dental records are protected and used. You’ll consent to treatment, authorize us to discuss your care with you by phone or email, and confirm that you’ve reviewed our privacy practices.
How to Complete Your Forms
Download and print at home: Fill out the forms legibly in blue or black ink. Return them at your first appointment.
Complete them in our office: Arrive 15 minutes early and fill them out in our reception area. We’ll have forms available and a quiet place to work.
What to bring: Your insurance card, photo ID, a list of current medications and supplements, and any imaging or treatment records from another dentist.
Common Questions About Forms
Is my information confidential?
Yes. Your dental records are protected by HIPAA and stored securely. We share information only with your insurance company or as required by law, and only with your permission.
What if I don’t know my medication names?
Bring the bottles with you. Our team can verify the names and dosages. Even over-the-counter medications and supplements matter—some affect bleeding and healing.
Do I have to answer every question?
Answer as completely as you can. If a question doesn’t apply, write “N/A.” If you’re unsure or uncomfortable answering something, note it, and we’ll discuss it in person. Your honesty helps us provide the safest, most effective care.
What if I’m updating my information?
Existing patients should update their forms if your medications, allergies, or medical conditions have changed. Let us know at your appointment or call us at (847) 696-1919.
Ready to Schedule?
Complete your forms now or arrive early on the day of your appointment. If you have questions about any of the forms, call us at (847) 696-1919 or reach out to reception@drloukas.com.
See what your first visit involves or request an appointment now.
