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LJ Dentistry
A Great Dentist
Moline, East Moline, Rock Island and all surrounding Quad City areas.
Office Hours: M-Th:8-5 F:8-2

New Patient Forms

Help us get to know you!

Please take a moment and fill out our patient information form. If you have any questions along the way, feel free to contact our practice.

COVID-19 Screening

Existing Patient Update

New Patient - Adult

New Patient - Child

Privacy Policy

HIPAA Acknowledgment

Have Questions? Get in Touch
If you have difficulty using our website, please email us or call us at (309) 764-3242
View the ADA Accessibility Statement
As of June 1st, we will reopen the practice at normal business hours for elective care! We look forward to seeing you at your appointment!