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 if you have any questions.

 

New Patient Child Forms

New Patient Infant Forms

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
View the ADA Accessibility Statement

Thanksgiving Hours
Our office will be open on November 25th from 8:00am-1:00pm, and closed on November 26th and 27th.