Patient Forms
New Patient Forms
New patients at the SIU School of Dental Medicine are expected to complete the following forms. For your convenience, the following forms can be completed and printed off in advance of your appointment. Please bring these forms with you to your appointment.
Requesting Dental Records
If you need copies of your dental records and/or radiographs, please print, complete, and sign the forms below and return them to the SIU School of Dental Medicine. These forms are required prior to the release of your dental records and there is an associated fee. If you have any questions, please contact the Records Office at 618-474-7012.
