• Phone Icon Westmont (630) 541-8374
  • Location Icon

    519 N Cass Ave, Suite 102, Westmont, IL 60559

  • Phone Icon Villa Park (630) 541-8374
  • Location Icon

    101 E. St. Charles Rd,Suite 101, Villa Park, IL 60181

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Patient Forms

Patient Forms

Please Complete Prior To Your Appointment

Please click on the following forms to print and bring to your first appointment. You may also complete the smile assessment (not required).

Patient Registration

Medical History

Smile Assessment

Your smile has a lot of effect on your overall self-confidence and social interaction. Lots of people are afraid of smiling or laughing. You can easily assess your smile by answering the following questions. Stand in front of the mirror, make a wide smile, and try asking yourself these questions:

  • If you have answered yes to any of the above questions, Westgrove Dental is here to help. We can provide the solutions to help you get the smile you’ve always wanted. Fill out the form below and we will personally respond to your smile analysis.

    Or, if you are ready to schedule your appointment, call us today.


We Can’t Wait To Make You Smile!

Schedule Your Appointment Today!

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