Forms
For your assistance, the following forms can be printed from this web site and then either mailed or faxed to our office:
- Patient Registration/Health History Form - Needed for all new patients coming to our office, and then an updated version for all returning patients.
- HIPAA Form - Signature required at time of all new patient visits.
- Referral Form - For use by our referring dentists. Please feel free to either mail or fax this form to us when referring a patient. You may also include the referral information along with an x-ray via e-mail.
- Surgical Consent Form for Dr. Kolinski or Dr. Crosby - Required for all implant placement patients prior to surgical appointment.
As partners in private practice in St. Charles, Illinois, Martin Kolinski, DDS; Tricia Crosby, DDS, MS; and William Trahan, DMD, MSD, have collectively placed more than 30,000 dental implants. Their practice focuses on both the placement of implants and periodontal work. Crosby and Kolinski, who first partnered together in 2007, became interested in using laser technology to treat patients with peri-implantitis and periodontal diseases because of patient demand. After researching the LANAP® and LAPIP™ protocols—and ultimately using the technology—they were impressed by not only the patient acceptance but also the results. Trahan joined the practice in 2015 and also completed the live-patient training continuum.