Call 630 469 5385 to schedule an appointment

630.469.5385

Click to email Dr. Toth's office

Info@DrToth.us

505 Anthony, Glen Ellyn, Illinois 60137  Map & Directions

Click to email Dr. Toth

Welcome to our practice.  To make your first visit as painless as possible, please complete the two forms below and bring them with you to the office.

You may print the forms and write in the information on the forms.

Or using the free Adobe Reader you may key in your responses.  After opening the form in Adobe Reader, click on the box labeled Highlight Existing Fields to more easily see the fields to complete. When completed, please be sure you print the forms and bring them with you to your first visit..


Click to download the free Adobe Reader

Click the form name to print


Click the form name to complete online and then print

Patient Registration & Consent

Click for Patient Registration and Consent form


Patient Registration & Consent

Click for Patient Registration online form

Medical & Dental History

Click for Medical and Dental History form


Medical & Dental History

Click for Medical and Dental History online form