Braces Orthodontics – Grayslake Wonder Lake IL – Orthodontist(s) Terry Sellke Donald Reily – Illinois 60002 60030 60097

1138 South Main Street
Antioch, IL 60002
TEL (847) 838-0105

30 North Slusser Street
Grayslake, IL 60030
TEL (847) 223-2876

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Help us be prepared for your first visit by completing the patient information form prior to your first visit.

Either fill out the online version or print the printable version, fill out, and bring with you to your first vist.

Online Health History Form
[Grayslake Location]
[Antioch Location]

Printable Health History Form [PDF]

We encourage you to view "Our Introductory Video" to get to know us better before your first visit with us.

 

 

 

 

 

 

 

 

 

 

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