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Patient Intake Forms

Save Time at the Office!
Click on the PDF Patient Intake Form (below left), then download the form, fill it out and bring it it with you to your appointment.
OFFICE HOURS    
Mon
10:00 - 6:00
Tue
Closed
Wed
10:00 - 3:00
Thu
10:00 - 6:00
Fri
Closed
Sat
9:00 - 3:00
Sun
Closed
6444 West Belmont Avenue Unit A
Chicago, IL 60634
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OFFICE PHONE
(773) 777-6788
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Steven R. Salzman, DDS 6444 West Belmont Avenue Unit A Chicago, IL 60634 Phone: (773) 777-6788

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