Patient Forms


 

Please take a minute to print and fill out the patient information form before your first appointment:


Patient Registration and History Form PDF


If you’re unable to open PDF files, you can get Adobe Reader® for free.

Location
Jefferson Park Smile Corner
4748 North Milwaukee Avenue, Suite 1
Jefferson Park

Chicago, IL 60630
Phone: 773-219-0610
Office Hours

Get in touch

773-219-0610

Charles Lockhart, DDS, MAGD
4748 North Milwaukee Avenue
Suite 1
Chicago, IL 60630