Please click on any of the following links to download and fill out our new patient forms before coming in for your visit!
Patient Information Form Child
Patient Information Form Adult
Model Release Contract
Disclosure of Dental Information
Use Your Medical Insurance For Your Dental Procedures
We are happy to announce that we are now working with a company that is bridging the gap between Medical and Dental, meaning there are certain dental codes that may be submitted to your medical insurance and receive payment. The company is helping us use your medical benefits for some of your dental procedures to possibly offset costs to you. In order to do this, we need your Medical Insurance information. Getting a copy of your card would be the most helpful. However, if that is not possible, we need the Insured Subscriber’s Name and Date of Birth, ID Number, and Group Number, along with the Medical Insurance Carrier’s name, address (where to submit claims) and phone number. You can either email us back, fax the information to 847-342-0131, or send it to us in the mail. For convenience, if you have a smart phone, you can also take a picture of the front and back of the insurance card and email it to firstname.lastname@example.org.
Do you Take My Insurance?
Viewing Your Smile From Different Respective
This seems to be the first question people ask when they call our office!
Yes we take all major dental insurance expect HMO.
We are an out of network provider, all that means is that we will give you the very best dental care available. Your insurance will pay their portion up to your maximum. This is normally between $1,000 to 1,500. We use only American made product and American labs; so we are confident in what goes into your mouth!
Don’t be number in a big corporate dental office; find someone that cares about you and what goes into having that great smile, it is time to stop being treated by people that just don’t care.
Dr. Mike always stands by his work, Remember our patents are part of our family not just number.
Michael R. Errico DDS, FAGD, FICOI & Associates
Serving the Northwest Chicago Suburbs starting with Dr. Ronald Errico and passing on to Dr. Mike for over 55 yrs.
Please give us a call 847-788-0808. We would love to you to be part of our dental family.
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