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A relaxed and caring atmosphere to meet your dental needs.

Beecher Phone #: (708) 946-3777
St Anne Phone #: (815) 427-6880

Home
Meet The Doctor
Our Services
Patients
Request Appointment
Office Locations
Contact Us

Coats DDS Waiting Room

Dr. Christine Coats DDS IL

X Ray Prep Dr. Coats DDS

X Ray Review Coats DDS Beecher

Record Request Consent

The office of Christine M. Coats DDS has my permission to obtain the necessary radiographs and/or treatment notes and records for the following patients:*
- I Agree
Date (mm/dd/yyyy)
Patient 1: Name
Patient 1: DOB
Patient 2: Name
Patient 2: DOB
Patient 3: Name
Patient 3: DOB
Patient 4: Name
Patient 4: DOB
Patient/Parent/Guardian Signature*
Requested From:
Office Name
Doctor Name
Phone Number
Fax Number
Street Address
City, State, Zip

Beecher Location

Serving Will Township, Crete, Monee, Grant Park, Peotone, Chicago Heights, parts of Indiana, and surrounding areas.

Office Hours:

Monday: 8:30 am - 5:00pm
Tuesay: 8:00 am - 5:00 pm
Thursday: 8:00 am - 6:00 pm

Address:

612 Dixie Hwy
Beecher, IL 60401

(708) 946-3777

St. Anne Location

Serving patients from Papieau, Momence, Kankakee, Aroma and beyond.

Office Hours:

Wednesday: 8:00 am - 6:00pm
Friday: 8:00 am - 5:00 pm

Address:

100 Dixie Hwy
Saint Anne, IL 60964

(815) 427-6880

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