Accessible Version
Children's Center for Dentistry
GREGORY DIETZ DMD

New Patient Forms

Save time waiting in our office by filling out necessary forms at home. Feel free to give us a call at (309) 827-5437 if you have any questions.

New Patient Child Forms

New Patient Infant Forms

Update Patient Information

COVID-19 Screening Questionnaire

Have Questions? Get in Touch
If you have difficulty using our website, please email us or call us at (309) 827-5437
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Happy Holidays!

Our office is CLOSED for the holidays from 12/23/2022 through 1/2/2023
  
We will reopen on 1/3/2023