New Patient Information & Forms

Sliding Fee Description

Sliding Fee Scale Application

Sliding Fee Scale Application Spanish

Patient R&R (English)

Patient R&R (Spanish)

Permission for Treatment of Children

Record Release (to WMHC)

Medical History (English and Spanish)

Medical Clearance for Dental Treatment

HIPAA Notice of Privacy Practices

Dental Child Medical History – Bilingual_Spanish

Dental Child Medical History – Bilingual_Russian

Dental Medical History – Bilingual_Spanish

Dental History – Bilingual