FORMS:

Download forms before completing and printing.

New Patient Registration

ROI-Patient Authorization for Release of Information

Eligibility Determination Worksheet

Patient History Form

Dental Emergency Clinic Walk-In Form

Consent to Treatment

Consent to Treatment of a Minor

Telehealth Informed Consent

Designation of Personal Representative

Patient Grievance Form

NOTICES:

NOTICE OF PRIVACY PRACTICES

PATIENT RIGHTS & RESPONSIBILITIES