Dentist in Chicago Heights, IL Accepting New Patients

At A Lasting Smile, your dentist in Chicago Heights, IL is always welcoming new patients. Whether you live in Chicago Heights, or surrounding areas such as Flossmoor or Olympia Fields, we encourage you to schedule your first appointment today. The high-quality care and service offered within our office doors cannot be matched.
Our friendly office staff strives to create a dental visit that is simple and stress free. One way we achieve this, is by providing our new patients with our registration form online. Patients can review, print, and carefully fill in their paperwork at their leisure and in the comfort of their own home. Save yourself time and the hassle of completing it once you arrive.
If you have any questions while completing the registration form below, please feel free to call our office. We look forward to hearing from, and seeing you soon.

Patient Registration Form PDF 

Appointment request

Need an appointment with a dentist in Chicago Heights ? Requesting an appointment at our Chicago Heights, IL family and cosmetic dental office is now easier than ever. Fill out the form below and we'll contact you to find a time that fits your schedule. Start your journey towards a beautiful smile with us today!
Patient Name*
Phone Number*
Email Address
Are you a current patient?
Best time(s) to call?
Preferred Appt Date
Preferred Appt Time
Describe the nature of your appointment or any other comments