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Mon–Thu 8:00 AM – 5:00 PMFri–Sun Closed

(309) 243-8455
Martin Ruelas, DMD

Patient Forms

New patient forms to print and complete before your first appointment at the practice.

Completing your paperwork before you arrive saves time in the waiting room and means your first appointment starts on time.

These forms are printed and filled in by hand, then brought with you. There is no online form here, and that is deliberate — your medical history is not something this website collects, stores or transmits.

More about this

If you are a new patient to our office, the attached file contains our new patient bundle with forms that will need to be filled out when you arrive at our office. Printing them, filling them out and bringing them with you will allow us to attend to your medical needs more quickly than completing them on your arrival. Thank you and please call our office if you have any questions at all.

Patient Forms ( Print & Complete All Forms Prior To First Office Visit)

This web site uses files in Adobe Acrobat Portable Document Format (pdf) which require Adobe® Acrobat® Reader for viewing and printing. It is available to download free.

We encourage you to contact us with any questions or comments you may have. Please call our office or use the quick contact form below.

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Martin Ruelas, DMD, PC

Dare to have the smile you've always wanted.

10330 North Juliet Court
Suite 1
Peoria, IL 61615

(309) 243-8455 Fax (309) 243-8466

Office hours

  • Mon–Thu 8:00 AM – 5:00 PM
  • Fri–Sun Closed

Closed Friday through Sunday. Requests sent over the weekend are answered on Monday.

© 2026 Martin Ruelas, DMD, PC. All rights reserved.

Serving Peoria and Dunlap, Illinois.