Skip to content
Call Wheaton: (630) 469-7696
722 S President St, Wheaton, IL 60189
Call St. Charles: (630) 883-0856
1203 E Main St, St. Charles, IL 60174
Call St. Charles: (630) 883-0856
Call Wheaton: (630) 469-7696
Contact Us
Patient Portal
Home
About Us
Meet Our Providers
Meet Our Team
Office Tour
Technology
Testimonials
Patient Education
Our Services
Adult Orthodontics
Emergency Dental
Frenectomies
Orthodontics
Invisalign
Laser Dentistry
Pediatric Dentistry
Wisdom Teeth Removal
Sedation Dentistry
Special Needs Dentistry
St. Charles
Orthodontics
Invisalign
Wisdom Teeth Extractions
Dental Emergencies
Frenectomies
Laser Dentistry
Oral Surgery
Sedation Dentistry
Wheaton
Dental Emergencies
Dental Cleanings & Exam
Orthodontics
Early Orthodontic Treatment
Braces
Invisalign
General Dentistry
Oral Surgery
Dental Bonding Fillings
Dental Crowns
Dental Sealants
Frenectomies
Laser Dentistry
Patients
Patient Portal
Pay My Bill
Insurance & Financial
Post Procedure Care
Health & Safety
COVID-19 Update
Surgically Clean Air
Contact Us
Referrals
Request For School Form
Menu
Home
About Us
Meet Our Providers
Meet Our Team
Office Tour
Technology
Testimonials
Patient Education
Our Services
Adult Orthodontics
Emergency Dental
Frenectomies
Orthodontics
Invisalign
Laser Dentistry
Pediatric Dentistry
Wisdom Teeth Removal
Sedation Dentistry
Special Needs Dentistry
St. Charles
Orthodontics
Invisalign
Wisdom Teeth Extractions
Dental Emergencies
Frenectomies
Laser Dentistry
Oral Surgery
Sedation Dentistry
Wheaton
Dental Emergencies
Dental Cleanings & Exam
Orthodontics
Early Orthodontic Treatment
Braces
Invisalign
General Dentistry
Oral Surgery
Dental Bonding Fillings
Dental Crowns
Dental Sealants
Frenectomies
Laser Dentistry
Patients
Patient Portal
Pay My Bill
Insurance & Financial
Post Procedure Care
Health & Safety
COVID-19 Update
Surgically Clean Air
Contact Us
Referrals
Request For School Form
Home
Records Release
Records Release
Oral Surgery
DPD
Pediatrics Orthodontics
Wheaton Office
722 S. President St. Wheaton, IL 60189
Call: (630) 469-7696
Hours
Monday: 8:00 am - 4:30 pm
Tuesday: 8:00 am - 4:30 pm
Wednesday: 8:00 am - 4:30 pm
Thursday: 8:00 am - 4:30 pm
Friday: By Appt. Only
Saturday: By Appt. Only
Sunday: Closed
St. Charles Office
1203 East Main Street St. Charles, IL 60174
Call: (630) 883-0856
Hours
Monday: 8:00 am - 5:00 pm
Tuesday: 8:00 am - 5:00 pm
Wednesday: 8:00 am - 5:00 pm
Thursday: 8:00 am - 5:00 pm
Friday: By Appt. Only
Saturday: By Appt. Only
Sunday: Closed
Select Your Location:
St. Charles
Wheaton
Patient Name
Patient DOB
Parent Name
Consent for digital communications *
Reason for Records Request: (Select All that Apply) *
Changed Dental Office
Specialist
Insurance Request
Moving
Other
Should We Cancel All Future Appointments With Our Office? *
Yes
No
New Provider/Office Name
Email to Receive Records
By checking this box, I confirm that I am the parent or legal guardian and give my consent for the release of my child's records.
Send
Patient Name
Patient DOB
Parent Name
Consent for digital communications *
Reason for Records Request: (Select All that Apply) *
Changed Dental Office
Specialist
Insurance Request
Moving
Other
Should We Cancel All Future Appointments With Our Office? *
Yes
No
New Provider/Office Name
Email to Receive Records
By checking this box, I confirm that I am the parent or legal guardian and give my consent for the release of my child's records.
Send
