Peter J Waidzunas, DDS, Ltd

 

Windsor Court I Office Centre

501 N. Riverside Dr.  Suite 119

Gurnee, Illinois, 60031

847-336-7300

gurneedental.com

Most of the forms that we require are available below.

 

  • Patient Information Form
    • This form should be filled out electronically prior to your first office visit.  Please see instructions on form
    • Please use this code when requested on form 0402-AFECA3
  • Patient Medical History
    • Please use this code when requested on form 0402-AFECA3
  • HIPAA Form
    •  

 

 

    • This will direct you to their website to apply for 3,6 or 12 month interest – free financing.  Longer financing is available - special terms apply.

CONTACT

 

Phone: 1.847.336.7300

Windsor Court I Office Centre

501 N. Riverside Drive  Suite 119

Gurnee, IL  60031