Benjamin C. Youel DDS, MS
160 Commerce Drive,
Suite 101
Grayslake, IL 60030
Tel: 847-548-4330
Patient Forms
Please take a minute to print and fill out the patient information form before your first appointment:
» GO HIPAA Consent [PDF]
» GO Notice of Privacy Practices [PDF]
» Ortho Health History Spanish [PDF]
» Ortho Health History [PDF]
» Ortho Registration Spanish [PDF]
» Ortho Registration [PDF]
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