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New Patient Forms

Please download and complete our Patient Registration Form. You can then bring it at your child’s first visit to our office.
New Patient Registration Form
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Call us at 630-984-8811, or complete the form below. 

New Patient Offers:

Complimentary Second Opinion Consultation or a FREE School Exam.

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  • Monday 9:00 - 6:00
  • Tuesday 9:00 - 6:00
  • Wednesday 9:00 - 5:00
  • Thursday 9:00 - 5:00
  • Friday 9:00 - 3:00
  • Saturday 9:00 - 3:00
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Disclaimer: Dr. Moss treats children of all ages and does not hold a license in the specialty of pediatric dentistry.