To request an appointment, please fill out and submit the form below. We will contact you to make the necessary arrangements for your appointment.

Please note this request form is for non-urgent appointments only. If you have an Orthodontic problem that you feel requires urgent attention, please contact us directly by phone @ 847-615-KIDS.

   


I would like to (choose one):


Are you currently a patient with us?
If you are a new patient, where did you first hear about the practice?