New Patient Forms - C.J.W. & Associates

Thank you for choosing C.J.W. and Associates and Schaumburg / Palatine dentist Dr. Corey Walther for your dental needs.

Please review and download the forms below, complete them and bring to your first appointment to make the visit as efficient as possible. Alternatively, you can also fill out these forms in person at our office. Also please bring your insurance card and driver's license.

If you have any questions or concerns, please do not hesitate to ask for assistance by calling our customer service at 847 882-3683 or fill out our contact form and you will receive a call back within 24 business hours. We will be happy to help.

-New Patient
-Insurance
-Privacy
-HIPPA

Technical Note: Our online forms use the Adobe Acrobat Plugin. Please download the free plug-in from Adobe's web site if it is not already installed on your system. It is important that you have version 5 of the plugin, in order to successfully use our form.



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