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

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