New to us here at Affiliated Dentists? Fill out our patient form beforehand to save time at your appointment with Dr. Andrew Jordan or Dr. James Day. If you have any questions about these forms and would like to speak with a team member before you meet with our dentists in Pontiac, Illinois, please contact us at 815-842-3550. We are always happy to assist you!

Patient Registration Form
Medical History Form
HIPAA Agreement
Text Consent
Financial Policy