815.786.2146

Patient Info

dental patientsWelcome to The Waters Dental Group! Our goal is to provide compassionate service from start to finish. From the front desk to the exam chair, our doctors and staff will treat you with kindness and friendliness to provide you with a sense of comfort each time you visit us. Everyone on our team is personally invested in your overall health, and we make sure you feel like a person and a friend, not just an appointment.

As a new patient, your first visit is very important, as it establishes the foundation of our relationship. During your initial visit, we will:

  • Obtain important background information from you, like your medical history
  • Discuss any and all dental wants and needs
  • Chart existing dental history, complete an oral cancer screening, check for gum disease, TMD, and general oral health

To prepare for your appointment:

  • Make a list of questions to ask our staff, so you don’t forget anything on the day of your appointment (this includes any concerns you have or oral problems you’ve been experiencing)
  • If you have dental insurance, remember to bring your insurance card with you

Patient Forms

HIPAA Form

Privacy Practices

Adult Form

Child Form

Your Rights as a Patient

  • You have a right to choose your own dentist and schedule an appointment in a timely manner.
  • You have a right to know the education and training of your dentist and the dental care team.
  • You have a right to arrange to see the dentist every time you receive dental treatment, subject to any state law exceptions.
  • You have a right to adequate time to ask questions and receive answers regarding your dental condition and treatment plan for your care.
  • You have a right to know what the dental team feels is the optimal treatment plan as well as the right to ask for alternative treatment options.
  • You have a right to an explanation of the purpose, probable (short and long term) results, alternatives and risks involved before consenting to a proposed treatment plan.
  • You have a right to be informed of continuing health care needs.
  • You have a right to know in advance the expected cost of treatment.
  • You have a right to accept, defer or decline any part of your treatment recommendations.
  • You have a right to reasonable arrangements for dental care and emergency treatment.
  • You have a right to receive considerate, respectful and confidential treatment by your dentist and dental team.
  • You have a right to expect the dental team members to use appropriate infection and sterilization controls.
  • You have a right to inquire about the availability of processes to mediate disputes about your treatment.

Your Responsibilities as a Patient

  • You have the responsibility to provide, to the best of your ability, accurate, honest and complete information about your medical history and current health status.
  • You have the responsibility to report changes in your medical status and provide feedback about your needs and expectations.
  • You have the responsibility to participate in your health care decisions and ask questions if you are uncertain about your dental treatment or plan.
  • You have the responsibility to inquire about your treatment options and acknowledge the benefits and limitations of any treatment that you choose.
  • You have the responsibility for consequences resulting from declining treatment or from not following the agreed upon treatment plan.
  • You have the responsibility to keep your scheduled appointments.
  • You have the responsibility to be available for treatment upon reasonable notice.
  • You have the responsibility to adhere to regular home oral health care recommendations.
  • You have the responsibility to assure that your financial obligations for health care received are fulfilled.

(Adopted by the American Dental Association in 2009)

Patient Forms

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Patient Education

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