Patient Forms

To help you prepare for your dental visit, we have provided the following patient forms on our website:

CLICK TO DOWNLOAD NEW PATIENT REGISTRATION DOCUMENTS

*Please email coop@westloopdental.com or fax 312-666-5177 your completed forms ahead of your appointment for faster check-in.

Financial Information

SUBMIT PAYMENT

We accept payment in cash, check, and credit card (MasterCard, Visa, Amex). All payments are due at time of service. If you have any questions about our financial policies, please give us a call. We will gladly assist you.

ABOUT CARECREDIT FINANCING

We want you to receive the excellent dental care you need in a way that is affordable for you. Before dental treatment, we will discuss with you your financial options and help you receive your insurance benefits.

We are pleased to refer our patients to CareCredit, a third-party financing option that breaks down your bill into affordable monthly payments with little or no interest.