Patient Forms

We strive to make the waiting room experience as enjoyable as possible to patients who come to our Glenview office.  We provide  informative resources about GLO Science Tooth Whitening, TMJ therapy, and our numerous other dental services.  For young children, we offer a wide variety of magazines and activities.

Still, most patients want to limit the amount of time they spend waiting for their appointment.

To best accomplish this, please take a minute to download the patient form and complete it prior to your next visit.  Don’t worry, you can still check out the latest issue of People or Highlights, or add to Dr. Malik’s extensive collection of children’s drawings!

If your child is in kindergarten or grades 2 or 6, the State of Illinois requires your child to have an oral health examination by a licensed dentist. This regulation applies to all children in these grades in public, private, and parochial schools.  Each child is required to present proof of examination by a dentist prior to May 15 of the school year.  The dental examinations must have been completed within the 18 months prior to the May 15 deadline.  We recommend appointments at least every six months, so please don’t wait to schedule your child!

The Proof of School Dental Examination form is available on the Illinois Department of Public Health website. We also have copies in our office.

Parents: please complete the top half of the form, and bring the form to your child’s appointment (or send it to us).  We will complete the bottom half, typically during your child’s appointment, and return it to you to submit to your child’s school.

To view the forms, you must have Acrobat Reader.  If you do not have this program, click here to install it.