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UIC COLLEGE OF DENTISTRY PATIENT REFERRAL Please provide all the information below and fax/email this form to: Changing the Future of Oral Health Date of Referral: Referring Practice/Provider:DEPARTMENT
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To fill out a Chicago dentist request, follow these steps:
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Start by gathering all the necessary information such as your personal details, dental insurance information, and any specific dental concerns or issues you have.
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Research and find a list of Chicago dentists that accept new patients and align with your specific dental needs.
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Visit the website or contact the chosen dentist's office to access their patient request form.
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Fill out the form accurately and provide all the required information, including your full name, contact details, dental insurance information, preferred appointment times, and any additional details about your dental needs.
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Double-check all the information you have provided to ensure its accuracy and completeness.
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Submit the filled-out form either through the online submission method or by mailing it to the dentist's office if specified.
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Wait for a response from the dentist's office regarding your request. They may contact you to schedule an initial consultation or provide further instructions.
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Keep track of your request by saving any confirmation emails or paperwork you receive from the dentist's office.
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If you do not receive a response within a reasonable timeframe, consider following up with the dentist's office to inquire about the status of your request.
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Once your request is accepted, follow the dentist's instructions for further appointments or procedures.
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Note: It is always recommended to do thorough research and read reviews before selecting a Chicago dentist to ensure you receive quality dental care.

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Chicago dentist - request is a form used to request dental services in the city of Chicago.
Anyone in need of dental services in Chicago is required to file Chicago dentist - request form.
To fill out the Chicago dentist - request form, you need to provide your personal information, dental needs, and preferred dental provider.
The purpose of Chicago dentist - request is to connect individuals in need of dental services with providers in Chicago.
On Chicago dentist - request form, you must report your name, contact information, dental issues, and preference for a dental provider.
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