Forms

Patient Forms –

Save time at your appointment by completing necessary forms in advance. Forms are also available at the front desk.

DENTAL

Consent for Services

Permission to Delegate Dental Treatment and Disclosure of Health Information

Policies and Procedures

Patient Medical History

NEEDED FOR ALL CLINICAL SERVICES

Demographics Form (English/Spanish)

List of Acceptable Documents for Proof of Identification

List of Acceptable Documents for Proof of Income

WIC

WIC PreScreening Tool

List of Acceptable Documents for Proof of Identification 

List of Acceptable Documents for Proof of Income

List of Acceptable Documents for Proof of Residence

Need help? Our staff is happy to assist you with forms or documentation. Interpreter services are available at no cost.

Provider Forms – 

COMMUNICABLE DISEASE

Communicable Disease Reporting Form and Instructions for Providers

Animal Bite Report Form for Providers