Monday - Thursday
7:30 am - 5:00
Convenient, Low
Monthly Payments
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Call Us 309.664.0570

908 N. Hershey Rd Suite 2, Bloomington, IL 61704

New Patient Forms

We recognize that your time is valuable. Bloomingfon Family Dental will make every attempt to honor your scheduled appointment time. To save time, please download and complete the New Patient Form.

You may fill this out on your computer or print it and fill it out by hand.

If you'd like to email your completed form please send it to

Otherwise, please bring the completed form with you and we look forward to seeing you at your first appointment.