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New Patient Information:
Welcome to our practice. We are so glad that you have chosen River Pointe Dental. In order to minimize your wait time in our office, we have posted all of our forms online so that you can view and print them in advance of your first visit. Just click on the form you wish to download and it will open in the browser allowing you to print a copy using the Adobe Reader. If you would like to download the forms to your hard drive, simply "right-click" on the link below and chose "save target as" you will then be prompted to find a place to store the file. Once completed simply fax the forms back to us or bring a copy to your appointment.

PATIENT REGISTRATION FORM (.pdf format - 15K)

MEDICAL HISTORY FORM (.pdf format - 18K)

CONSENT TO TREATMENT FORM (.pdf format - 24K)

HIPAA NOTICE OF PRIVACY PRACTICES (.pdf format - 30K)

HIPAA ACKNOLOWDGEMENT OF RECEIPT OF PRIVACY PRACTICES (.pdf format - 33K)

HIPAA CONSENT FOR THE USE AND DISCLOSURE OF HEALTH INFORMATION (.pdf format - 38K)

TEETH WHITENING INFORMATION AND CONSENT FORM (ZOOM/TAKE HOME (.pdf format - 55K)

In order to view these files you will need to make sure that the Adobe Acrobat Reader is installed on your computer. If you do not have the Adobe Acrobat Reader, simply click on the logo below and you will be redirected to an Adobe download site.
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DR. RACHELLE D. HARDY IS A LICENSED ILLINOIS GENERAL DENTIST
FOX RIVER GROVE -
912 W. Northwest Hwy, Suite 200, Fox River Grove, IL 60021 (847) 639-5300
HUNTLEY - 12080 Princeton Drive, Huntley, IL 60142 (847) 515-8600
Copyright ©2001-2005 - Rachelle D. Hardy, DDS, PC & River Pointe Dental of Huntley, LLC.
This website is wholly owned and maintained by Rachelle D. Hardy, DDS, PC. All rights reserved River Pointe Dental
and the River Pointe Dental logo are registered servicemarks
and trademark pending of Rachelle D. Hardy, DDS, PC