--- LaFox office: 630-762-0000 teuscher.dental@comcast.net

Electronic COVID-19 Pre-Appointment Form ⇒

     For the convenience of all patients! 

Please read and click NEXT to complete online.

When finished, click SUBMIT and your form is sent to a secure account .

Thank you!

 

Printable COVID-19 Pre-Appointment Form 

(a PDF for those who would prefer to print and complete

this form on hard-copy and bring to our office

rather than utilize the online Electronic option above.)