Call Chicago (773) 792-1043 Mon–Fri by appointment
Call Bourbonnais (815) 933-4121 Mon–Fri by appointment
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Patient Forms for Our Chicago & Bourbonnais, IL Offices

Patient filling out new patient forms

Save time at your first visit by filling out these forms before you come in.

You can fill them out on your phone or computer. Save the finished file and bring it with you. To sign, type your name on the signature line.

Prefer paper? Print the forms and fill them out by hand.

Visit Us

Visit Dr. Raffi General & Implant Dentistry

Chicago Office

6215 W Touhy Ave

Chicago, IL 60646

(773) 792-1043

Mon9:30am – 4pm
Tue9:30am – 5:30pm
Wed9am – 5pm
Thu9am – 11am
Fri10am – 1:30pm
Sat – SunClosed
Get Directions

Bourbonnais Office

876 N Convent St

Bourbonnais, IL 60914

(815) 933-4121

Mon9:30am – 4pm
Tue9:30am – 6pm
Wed9am – 5pm
Thu9am – 1pm
Fri9am – 1pm
Sat – SunClosed
Get Directions