Ruggless Dental

New Patient Forms

Save time waiting in our office by filling out necessary forms online. Feel free to give us a call if you have any questions.

Online Portal for New Patient Forms

New Patient Registration

New Patient Consent Form

Medical History Form

Dental History Form

Notice of Privacy Practices

Have Questions? Get in Touch
If you have difficulty using our website, please email us or call us at (217) 787-0212
View the ADA Accessibility Statement