845 North Michigan Avenue • Suite 953W • Water Tower Place • Chicago • IL 60611 • TEL. 312.337.3543 • fax. 312.337.5160

Patient Information

Download your patient forms here. Please fill them out and bring them with you to your appointment.

Medical History Form
Consent Form
HIPAA Form

Dental Insurance
In regards to dental insurance, please call us so we can speak with you directly in regards to our insurance policies.

Credit Cards
In an effort to make your dental care as affordable as possible, we do accept credit cards.

Privacy Policy
This privacy notice discloses the privacy practices for this website of Dr. Maryann Kelly and Dr. Sanya Kirovski.

We are the sole owners of the information collected on this site. We only have access to/collect information that you voluntarily give us via email or other direct contact from you.

We will not sell or rent this information to anyone.

We will use your information to respond to you regarding the reason you contacted us.

Unless you ask us not to, we may contact you via email in the future to tell you about new services, or for marketing purposes, or changes to this privacy policy.

If you feel that we are not abiding by this privacy policy, you should contact us immediately at 312-337-3543.

< Smile Gallery News >