Contact

  • Highland Park

  • 1893 Sheridan Rd. Suite 311
  • Highland Park, IL 60035
  • Phone: (847) 433-6636
  • Fax: (847) 433-2090
  • Email: info@leslieheffez.com

  • Downtown Chicago

  • 25 East Washington Ste #825
  • Chicago, IL. 60602
  • Phone: (312) 372-0411
  • Fax: (312) 372-0428
  • Email: info@leslieheffez.com

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Pre-Op Instructions

Patient Forms

Informed Consent for Oral Surgery

The Informed Consent for Oral Surgery form is necessary prior to any surgical procedure.

Consent for Dental Implants

The Consent for Dental Implants ( English | Spanish ) form is for placement of Osseointegrated implants.

Consent Orthognathic Surgery

The Consent for Orthognathic Surgery form must be complted prior to any jaw surgery procedure.

History and Physical

The History and Physical form must be completed by your Primary Care Physician prior to any procedure that is preformed in the hospital, along with any necessary labs prior to your surgery date.

HOSPITAL Consent for Transfusion

The Consent for Transfusion form must be completed prior to any procedure preformed in the Hospital.

HOSPITAL Procedure / Operative Consent

The Procedure / Operative Consent form must be completed prior to any procedure preformed in the Hospital.