Dentist Des Plaines Appointment Request

Need an appointment with a dentist in Des Plaines? Requesting an appointment at our Des Plaines, IL family and cosmetic dental office is now easier than ever. Fill out the form below and we'll contact you to find a time that fits your schedule. Start your journey towards a beautiful smile with Dr. Eva Hanna today!

 

Payments are due at the time services are rendered. We offer several payment options to make your treatment plans affordable. We accept most insurance plans including Kid Care. We will work with you and your insurance company to process your claims. We accept cash, checks, Master Card, Visa, and Discover credit cards. Citi Health Card- 3rd party payment programs designed for dental patients. They offer 0% financing for those patient that qualify. This can be used for co-payments, patients without insurance or any other procedures such as Invisalign and braces.

 

New Patient Forms

 
To accomodate all of our patients, 
our Doctors or staff speak the following languages:
 
Arabic, Bosnian, Croation, English
Polish, Romanian, Russian. Serbian, & Spanish
Patient Information (* denotes fields that are required)
Patient Name*
Phone Number*
Email Address
Are you a current patient?
No Yes
Best time(s) to call?
Morning Noon Afternoon Evening
Appointment Information
Preferred Appt Date
Preferred Appt Time
Message
Describe the nature of your appointment or any other comments