Patient Forms and Documents

Patient Forms

Complete the Patient Registration, Consent to Treat, and Patient Health Questionnaire form:

Patient Registration Form

Consent to Treat Form

Patient Health Questionnaire

Complete the Influenza Vaccine Consent form:

Influenza Vaccine Consent Form

Complete the COVID-19 Vaccine Consent form:

COVID-19 Vaccine Consent Form

Register your child for School-Based Health Services:

SBHS Sign-Up Forms

SBHS Sign-Up Forms - Spanish

We offer pediatric dental care through our on-site Tooth Mobile, providing convenient appointments for your family. Register your child for Tooth Mobile services:

Tooth Mobile Forms

Tooth Mobile Forms - Spanish

Prefer to print and bring your forms with you to your appointment? Download, complete, and print these PDFs:

• Patient Registration Form (PDF)
• Consent to Treat Form (PDF)
• Patient Health Questionnaire (PDF)
• Influenza Vaccine Consent Form (PDF)
• COVID-19 Vaccine Consent Form (PDF) 
• SBHS Sign-Up Forms (PDF)
• SBHS Sign-Up Forms – Spanish (PDF)
• Tooth Mobile Forms (PDF)
• Tooth Mobile Forms – Spanish (PDF) 

Not sure which one you need?

Give us a call and we’ll walk you through filling out the right forms for your situation.