Steven W. Seibert, DMD, Ltd and Associates Online Patient Registration

Periodontics Patient Registration In Champaign & Charleston IL

You may preregister with our office by filling out our secure online Patient Registration Form. After you have completed the form, please make sure to press the Submit button at the bottom to automatically send us your information.

On your first visit to our office, we will have your completed form available for your signature. The security and privacy of your personal data is one of our primary concerns and we have taken every precaution to protect it.

Patient Registration Form

After you submit the form, you will have the opportunity to securely upload and transmit images of you insurance card. Please call our office with any questions: Champaign Location Phone Number 217-398-4867

Office Hours

Monday:   7:00am - 4:30pm
Tuesday:   7:00am - 5:00pm
Wednesday:   7:00am - 1:00pm
Thursday:   8:00am - 2:00pm
Friday:   7:00am - 1:00pm

New Patient Information

Thank you for choosing Steven W. Seibert, DMD, Ltd and Associates. We strive to deliver the best diagnosis and treatment that our practice has to offer. We believe that these goals can be met through a continuous and open dialogue between you and our entire team.