Michele Shely Horton, DDS, FAGD
Ellena Kontos Vranas, DDS, FAGD
2210 Dean Street - Suite H
St. Charles, IL 60175
PH. (630) 377-1010
FX. (630) 377-1091

Appointment Request Form

If you are interested in scheduling an appointment with Dr. Horton or Dr. Vranas feel free to fill out and send the form below. We will respond to your submitted appointment request as soon as possible. If you are requesting an appointment because you are experiencing a dental emergency or if you would like a faster response, please call us at (630) 377-1010.

 

First Name: Last Name: Choose which doctor you'd like to visit.
Address: Preferred Dates: Prefered Time Frame:
City:
Please describe symptoms or purpose of visit.
State: Zip Code:
Phone: Email:
   

 

Patient Forms

To the right are a few forms that we may require to have on file for you. Save time by printing and filling them out prior to your visit, then simply bring them with you to your appointment.

Please click on the appropriate form to open the PDF formatted printable document. To open the PDF you’ll need the Adobe® Acrobat® Reader. You can download a free reader here.

 
Welcome Form
Welcome Form
for a Child
Consent for Dental
Treatment of Minor