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New Patient Information

Thank you for choosing Orland Family Dental for your dental needs.  Please download & fill out the 3 applicable forms to bring to your appointment.  We look forward to seeing you.

HIPPA Notice of Privacy Practices (for your reference)

Adult Patients:  (1) Registration (Adult), (2) Acknowledgement of Receipt of Privacy Practices & Confidential Communications, (3) Financial Policy

Child Patients (under 13 years): (1) Registration (Child), (2) Acknowledgement of Receipt of Privacy Practices & Confidential Communications, (3) Financial Policy

  

If you have insurance, we will submit a form for you on your behalf. However, the patient (or responsible party) is ultimately responsible for payment. We accept the following forms of payment: Cash, Debit, Check, Visa, MasterCard, Discover, American Express, Apple Pay and Care Credit.

Payment for services is due at the time services are rendered unless prior arrangements have been made with the financial coordinator.


Ready to book an appointment?  Click here.

Riverside Dentists at Orland Family Dental are dedicated to family dentistry such as Exams, Teeth Whitening, Veneers and more. We are looking forward to your visit to our Riverside, Illinois dental office.


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