New Patient Registration
Download your form, fill it in at home, and send it back whichever way suits you.
Getting your paperwork done before you arrive means your first appointment starts on time and you spend it with the dentist rather than the clipboard. The form below is the same one we would hand you at the front desk.
New Patient Registration Form
PDF · 1 page · Print or fill in on screen
Covers your contact details, your insurance information, and two short questions about what brings you in. Filling in the insurance section lets our team verify your benefits before your visit, at no charge to you.
Download the FormSending it back to us
Any of these is fine, and none of them is required before your appointment. If it is easier to bring it with you, bring it with you.
Email it
Attach the completed form and send it to bandrdentists@gmail.com.
Fax it
Print the completed form and fax it to (630) 427-1801.
Bring it with you
Hand it to the front desk when you arrive. Come about ten minutes early if you would rather fill it in here, or call (630) 427-1800 and we will go through it with you.
A note about email
Ordinary email is not encrypted, so it is not a private way to send personal information. Plenty of patients email their form anyway and that is entirely their choice to make. If you would rather not, the fax number and the front desk are there for exactly that reason.
We do not collect any of this through the website. Nothing you type into the PDF is sent anywhere until you choose to send it.