Patient Forms

We want to welcome you to the Jill Kinsella, DMD family!

We are glad that you are interested in becoming a patient of Dr. Jill Kinsella’s Scott AFB, IL dental practice. New patients are always welcome here. Everyone at Jill Kinsella, DMD is committed to making your visits pleasant and stress-free. You can count on our friendly, highly experienced staff to always provide the highest standard of dental care in a clean, state-of-the art environment. Your comfort is our top priority.

We look forward to seeing you soon!

Dr. Jill Kinsella and her Dental Team


Click below to download New Patient Registration Materials


Medical History Form

Patient Registration Form

Notice of Privacy Form

General Office and Financial Policy

Dental Services Financial Agreement

Your Billing Rights