Patient Bill of Rights and Responsibilities
Dental Patient Medical History Form
School-Based Dental Center Medical/Dental History (Fillable)
School-Based Dental Center Medical/Dental History (Non-Fillable)
Consent to Disclose Health Information
Consent to Disclose Verbal Health Information
Advance Directive Information and Form
Translated Materials
Patient Registration Form – Arabic
Patient Registration Form – French
Patient Registration Form – Nepali
Patient Registration Form – Somali
Patient Registration Form – Spanish
Patient Registration Form – Swahili
Patient Registration Form – Vietnamese
Medical/Dental History Form – Arabic
Medical/Dental History Form – Burmese
Medical/Dental History Form – Dari
Medical/Dental History Form – Nepali
Medical/Dental History Form – Pashto
Medical/Dental History Form – Somali
Medical/Dental History Form – Vietnamese
School-Based Dental Center Medical/Dental History Form – Arabic
School-Based Dental Center Medical/Dental History Form – French
School-Based Dental Center Medical/Dental History Form – Nepali
School-Based Dental Center Medical/Dental History Form – Somali
School-Based Dental Center Medical/Dental History Form – Spanish
School-Based Dental Center Medical/Dental History Form – Swahili
School-Based Dental Center Medical/Dental History Form – Vietnamese
Consent to Disclose Health Information – Arabic
Consent to Disclose Health Information – French
Consent to Disclose Health Information – Nepali
Consent to Disclose Health Information – Somali
Consent to Disclose Health Information – Spanish
Consent to Disclose Health Information – Swahili
Consent to Disclose Health Information – Vietnamese
Consent to Disclose Verbal Health Information – Arabic
Consent to Disclose Verbal Health Information – French
Consent to Disclose Verbal Health Information – Nepali
Consent to Disclose Verbal Health Information – Somali
Consent to Disclose Verbal Health Information – Spanish
Consent to Disclose Verbal Health Information – Swahili
Consent to Disclose Verbal Health Information – Vietnamese
Sliding-Fee Scale Application – Arabic
Sliding-Fee Scale Application – French
Sliding-Fee Scale Application – Nepali
Sliding-Fee Scale Application – Somali
Sliding-Fee Scale Application – Spanish
Sliding-Fee Scale Application – Swahili
Sliding-Fee Scale Application – Vietnamese
Patient Rights and Responsibilities brochure – Arabic
Patient Rights and Responsibilities brochure – Burmese
Patient Rights and Responsibilities brochure – Nepali
Patient Rights and Responsibilities brochure – Somali
Patient Rights and Responsibilities brochure – Vietnamese
Notice of Privacy Practices brochure – Arabic
Notice of Privacy Practices brochure – Dari
Notice of Privacy Practices brochure – Farsi
Notice of Privacy Practices brochure – French
Notice of Privacy Practices brochure – Nepali
Notice of Privacy Practices brochure – Pashto
Notice of Privacy Practices brochure – Somali
Notice of Privacy Practices brochure – Swahili
Dr. Dynasaur Health Coverage info-Arabic
Dr. Dynasaur Health Coverage info-Burmese
Dr. Dynasaur Health Coverage info-Mandarin
Dr. Dynasaur Health Coverage info-Nepali
Dr. Dynasaur Health Coverage info-Somali
Dr. Dynasaur Health Coverage info-Vietnamese