We Welcome New Patients
We accept new patients of all ages. You will have the opportunity to meet with our team and get to know Drs. Teruyuki Hatakeyama, Ashlie Petrilli, and Thomas Hatakeyama. We are committed to educating you about your dental needs and will answer any questions you may have concerning your treatment.
Our goal is to provide you with the highest level of dental care available today. Thank you for your confidence in our dental office and we look forward to meeting you.
New Patient Forms
To provide you with the most efficient new patient experience, please download and complete the forms below and bring them to your first appointment. Our team will take comprehensive records and address any concerns or questions you may have. If you have any problems downloading the forms, please contact our office and we will gladly send them to you.
- Patient Information
- Dental History
- Health History
- Health History (Japanese)
- Cancellation Policy
Your First Visit
Your first visit with us may include:
- Comprehensive oral examination
- Full mouth digital x-rays
- Oral cancer screening
- Oral hygiene instruction
- Teeth cleaning
- One-on-one consultation with our dentist to discuss your needs, concerns, goals, and treatment options
During your visit, we will answer any and all questions about your oral health. We will provide a detailed financial consultation to ensure your treatments are timed effectively and affordably.
Insurance and Billing
At Hoffman Estates Dental Professionals AMITA HEALTH/St. Alexius Medical Center, . Dr. Hatakeyama, Dr. Petrilli, and Dr. Hatakeyama, are all Delta Dental Premier providers. Dr. Ashlie Petrilli and Dr. Thomas Hatakeyama are PPO proivders for MetLife, CIGNA, Dental Network of America, Principal, Guardian, Humana, and Blue Cross/Blue Shield.
Dental Insurance is different from Medical Insurance. Many patients aren’t familiar with the specifics of their dental insurance benefits. Insurance benefits are based on the agreement your employer negotiated with your insurance carrier, not your dentist. Please review the insurance booklet provided by your employer to better understand your insurance benefits.
An estimate of the amount covered by your insurance company will be provided at the time of your treatment, based on the information they provide to our office. The estimate is never a guarantee of benefits, or the amount that will be paid. As a courtesy, we will file all insurance claims to your insurance. This does not however, transfer the responsibility of your financial obligation to the insurance company. If the amount paid by the insurance company is less than anticipated, you are financially responsible for the difference. Each patient is responsible for paying for the deductible and co-payments on the day treatment is rendered.
We provide multiple financing options to ensure you can receive the treatments you need with a plan you can afford. For your convenience, we accept payments made by cash, check, and credit card (Mastercard and Visa). We also have an in-office financing plan, and you can learn more about that by contacting our office. Please give us a call if you have any questions about our financial options. We are happy to assist you in any way we can.