Logo Home

New Patient Forms

In order to provide the absolute best care possible, we need to learn what makes you uniquely you.


We ask that all forms be filled out at least 48 hours before your appointment. This provides our clinical team sufficient time to prepare for your visit. Kindly note we will reschedule your appointment if this important step is not completed in time. 


Our intake forms will take approximately 15 minutes to fill out and work best on a computer or tablet.


If you prefer paper or email copies, please contact our office at 630-420-9090 or GDG@GantosDentalGroup.com and we will mail them to you. Please feel free to contact our office with any questions or concerns at anytime.


To create your MyChart account and complete your online forms, please click on the button below. Be sure to check your spam folder if you do not see the registration email. Once you get to the very end, click the "X" in the top right corner of the trophy page.

MyChart Login

Uploading Documents to MyChart

To upload your insurance card, driver's license, or any other document to your patient account, please log in to MyChart and select the "Share Documents/Images" button towards the top right of the screen.

For a complete walkthrough, please check out these instructions: MyChart Instructions

First Visit Expectations

Below is an overview of what you can expect during your first visit to Gantos Dental Group.


Your first visit is an important time for our team to get to know you and also you to get to know our team. Please let us know your comfort menu preferences and we will have them waiting for you. Kindly plan on being in our office for approximately 90 minutes for the initial meeting (future visits are quicker!) During this first visit, we will work to better understand your priorities and oral health goals. We will also review your medical and dental history along with any medications or supplements you may be taking that can impact your oral health. We always encourage our patients to ask questions and express any concerns or sensitivities they would like addresed.


Next we will complete a complimentary oral cancer screening using Velscope technology, acquire a complete set of digital radiographs, and capture photos of your teeth using our digital camera. A gum and bone exam will be completed. If no signs of periodontal disease are present, you will have a routine cleaning. If signs of periodontal disease are noticed, we may reschedule the cleaning portion of your visit to allow for more time.


After gathering this data, our doctor will complete a comprehensive oral evaluation to thoroughly examine the head and neck, jaw joints, gums, teeth, bite, and dentofacial features. Once your exam is complete, the doctor will discuss all findings and recommendations. Together we can create a healthy, effective prevention and treatment plan that best meets your dental and personal needs. We can prioritize and stagger any treatment visits to give you a smile you deserve in a timeframe you can afford.


Finally, we want you to know we will go above and beyond to make you feel relaxed and safe. Not only is your physical comfort important to us, but your emotional well-being is, too. We are able to "edit down" the first visit to accommodate anxious patients and we will always work hard to make your visits a positive experience. Please let us know at any time if there is anything we can do to make your visit even more exceptional! 


Who We Serve

Our office serves patients of all ages, genders, backgrounds, cultures, beliefs, and preferences. We value diversity in our dental family and celebrate our patients as individuals. Our office has a zero tolerance policy for anyone who does not provide this same level of consideration to our team or other patients.


We afford equal treatment and respect free of shame, judgement, or embarrassment. We understand the dental office can often elicit a variety of emotions and our team works hard to understand each patient's comfort level, adapting as needed. There is no amount of dental fear or anxiety that we cannot overcome together.


Our office and treatment goals are really focused more on quality, comprehensive care. We believe in taking a thoughtful, global approach to healthcare, focused on personalized risk assessment and customized care. We know when we take this approach, we can focus on individual wellness and be more proactive instead of reactive to disease.

Financial Information

We want to help you receive the dental care you deserve! We discuss all cost and payment options with you to make sure you are comfortable with your treatment plan, and to answer any questions you may have prior to rendering care. We work hard to ensure there are no surprises when it comes to your bill.


Dental Insurance

We want you to get the most out of your budget, so we work with your insurance provider to ensure you get the best coverage available to you. Our office will file all insurance claims on your behalf and follow up as needed for any oustanding payment.

We work with all PPO plans but are considered out-of network. For many insurance policies, seeing an out-of-network provider makes little to no difference in out of pocket expenses; however, for some insurance policies, it can make a more substantial difference. If you need assistance, or have questions about your insurance policies or claims, our staff is knowledgeable and always available to help you. Our team can provide you with a complimentary benefits analysis to better understand your coverage in our office. To ensure we are able to provide adequate time with each patient, and the highest quality care, we do not participate with HMO/DMO or Medicaid plans. 


Popular Payment Options

We accept cash, checks, and most major credit cards. We also work with third-party financing companies like  CareCredit so you can get the care you need, when you need it.

Patient Rights & Responsibilities

At our office, we pride ourselves on forming life-long, professional relationships with our patients!


We want you to be well-informed and have a clear understanding of both your rights, and responsibilities within the practice.

The following is intended to promote our mission, while fostering your dignity, autonomy, and involvement in your care.


You have the Right to...


Patient-Centered Care

  • Receive comprehensive, considerate, quality dental care that respects your culture, beliefs, preferences, and values
  • Be treated with courtesy, respect, and the highest professional, ethical, and moral conduct by our team
  • Schedule appointments and receive care in a timely manner


Comfort and Safety

  • A safe, clean environment that is compliant with all infection-control standards
  • A smoke-free environment
  • Be comfortable during and after your dental procedure and/or have a family member, friend, or other individual present with you for emotional support
  • Receive reasonable arrangements


Privacy and Confidentiality

  • Privacy of your health information and dental record
  • Privacy in discussions, examinations, and treatment


Participate in Treatment

  • Know the names, education, and training of your providers
  • Be informed about your diagnosis, prognosis, treatment options, risks, benefits, and alternatives
  • Receive a fee estimate for all recommended treatment and understand how you will be expected to pay
  • Request an itemized bill, examine it, and receive an explanation of it, regardless of the source of payment for services rendered
  • Seek a second opinion any time you would like one and receive all digital x-rays at no cost
  • Be informed about continuing health needs
  • Consent or refuse treatment and understand any associated consequences



You have a Responsibility to...


General Considerations

  • Provide honest and complete information and report all changes in medication, insurance, and contact information promptly
  • Provide feedback about services and policies so we can continue to serve you best
  • Let us know your needs and preferences to make your experience as comfortable and easy as possible


Maintaining Appointments

  • Keep scheduled appointments— Repeated late, missed, or cancelled appointments impact our ability to provide quality care and will result in your dismissal from the practice
  • Provide at least 48 hours notice for rescheduling to allow other patients the reserved time block and prevent a $50 late fee from being billed to your account — Extenuating circumstances will always be considered
  • Be timely for appointments— Failing to show up, arriving more than 15 minutes late, or minors (under the age of 18) without a legal guardian present will result in a $50 late fee
  • Confirm appointment— Unconfirmed appointments will be cancelled 48 hours before the scheduled visit once multiple attempts to confirm a visit have gone unanswered


Financial Policy

  • Pay for services by the time they are rendered— A monthly service charge is applied to all unpaid balances on accounts not paid in full within 90 days of the treatment date
  • Pay any outstanding balance for yourself or dependents that is not fully covered by insurance — We will always maximize your insurance benefits first
  • Pay a service charge of $25 for any returned check
  • Contact our office promptly to communicate any financial hardships or concerns so we may assist you in the management of your account


Treatment Considerations

  • Participate fully in the decisions related to your care
  • Ask questions when you do not understand information or instructions
  • Follow post-operative and prevention tips at home

Notice of Privacy Practices

We partner with experts in cyber security and HIPAA-compliance to promote the highest level of protection for all medical records and personal health information. Each year we work with a cyber security consultant to conduct a risk analysis and review the controls we have in place and educate our team on the latest in cyber threats and any other conditions that could affect our patients. Our goals are to protect the confidentiality, integrity, and availability of all information that we store and keep.


As part of our security protocols, we do not work with third party companies that outsource any aspect of our business operations to ensure all federal laws and regulations are upheld in protecting your privacy information. All of our team members receive rigorous HIPAA-training and we have stringent protocols and safeguards in place to ensure that in the event of a disaster, your medical records will be preserved and accessible. We maintain PCI compliance and will never write down or store your credit card information. Through our credit card processing vendor, cards may be stored securely in an electronic vault but never viewed by any of team members.


Learn about our privacy practices here.

Share by: