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New Patient Forms

Exceptional Dental Care for the Entire Family

 

We want to welcome you to the City Smiles family!

We are glad that you are interested in becoming a patient of Dr. William A. Simon’s Chicago, IL dental practice. New patients are always welcome here. Everyone at City Smiles is committed to making your visits pleasant and stress-free. You can count on our friendly, highly experienced staff to always provide the highest standard of dental care in a clean, state-of-the art environment. Your comfort is our top priority.

We look forward to seeing you soon!

Dr. William A. Simon and the City Smiles team

 

New Patient Form - Adult

New Patient Form - Child

HIPAA Consent Forms

Appointment Payment Policy