Patient Forms

We want your first visit with our dentist and team to be a great one! Whether you are coming in for veneers, implants or just a regular cleaning and exam, you should be able to relax before your appointment starts and focus your energy on planning your new smile. To help you prepare, we have provided our office forms below. You can download, print and complete your forms and bring them with you when you come to see Dr. Sampalis, decreasing your time in our waiting room. As an added convenience, you can also fill out our online forms and submit them securely to our office online. Not only will you spend more time with our team, but Dr. [dr_last] will have more time to review your medical history in order to create your personalized treatment plan.

View Patient Form

If you have questions or concerns about paying for your dental care in Oaklawn, illinois, or would like to plan your visit, contact our team today at (708) 576-4073.

Call us at  (708) 576-4073

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(708) 576-4073
4560 W 103RD ST
OAK LAWN, IL 60453


Monday 9:00 a.m. - 7:00 p.m.
Tuesday 9:00 a.m. - 6:00 p.m.
Wednesday 9:00 a.m. - 1:00 p.m.
Thursday 9:00 a.m. - 7:00 p.m.
Friday 7:00 a.m. - 2:00 p.m.
Saturday 9:00 a.m. - 2:00 p.m.


We are in-network with traditional dental insurances and will gladly file claims on your behalf. Our office is proud to partner with CareCredit which is a company that may be able to finance up to 100% of your dental costs with low or even no down payments or interest rates.

© Andrew J. Sampalis, D.D.S. & Associates, Ltd

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