Due to the COVID-19 virus, our office is complying with the recommendations to reduce patient contact and temporarily close down to protect our patients, our staff and help slow the spread of this virus.  You can view a short update video by clicking HERE or you can read our most recent statement on the virus and our office by clicking HERE
Accessible Version
Robert C. Clay, Jr., DDS, Ltd.

New Patient Forms

Registration | Palos HeightsDid you know that you can download and print our registration forms before you come to your appointment?  You can download them, print them up, and then fill them out at your leisure before your scheduled appointment. Just be sure to bring them in with you when you come.   

Feel free to give us a call if you have any questions or any problems downloading or printing the forms.

Patient Registration Form

Medical History Form

Acknowledgement Of Receipt of HIPAA Privacy Pamphlet

Dental Insurance Form

Notice Of Privacy Pamphlet

Have Questions? Get in Touch
If you have difficulty using our website, please email us or call us at (708) 448-0273
View the ADA Accessibility Statement