We have provided our patient forms online for your convenience. We invite you to fill them out before bringing your child to meet with Dr. Jack Kalloch, Dr. Christa Spates or Dr. Sabeen Hafeez. This will save you time when you arrive and help streamline your experience at Just Kidz Dentistry. If you have any questions or to schedule your child’s appointment with our dentists in Peoria and Washington, Illinois, please give us a call today.
New Patient Forms
Printable PDF
New Patient Health History
Financial Policy
Insurance Assignment of Benefits
Dental Insurance Information
HIPPA Policy