New Patient Information and Forms

Your first visit to our office establishes a vital foundation for our relationship with you. During the first visit, we make sure to obtain important background information, such as your medical history and insurance information as well as give you ample time to get to know Dr. Block.

Dr. Nancy Block values your time and your privacy. That’s why we provided copies of our new patient information forms for you to download, print, and complete at home in advance of your appointment.

You may bring these forms into our office during your next visit. They will not be stored or sent online, but are offered here simply for your convenience. Dr. Block follows Federal HIPAA requirements for maintaining patient privacy and healthcare portability.

In order to view or print these forms you will need Adobe Acrobat Reader – Click here to download now.

Being well-prepared for your appointment will ensure that Dr. Block has all of the needed information to provide the best possible dental care for you. It also will help relieve any unnecessary anxiety you may be feeling. You can educate yourself on your symptoms by reviewing the content on this website. Also, take some time to review Dr. Block’s Executive Bio page and familiarize yourself with her experience and credentials.

We look forward to your first visit.

Dementia Care

New Patient Form

Confidential New Patient Information Form


About Dr. Nancy Block

Dr. Nancy Block is a licensed provider of General and Preventative Dentistry as well as Cosmetic and Restorative Dentistry and accepts most major dental insurance plans in Illinois.

Dr. Block treats patients in the Chicago Metro area including the neighborhoods of Lakeview, Lincoln Park, The Loop, Magnificent Mile, Old Town, River North, Streeterville, The West Loop and the Gold Coast.