Patient Registration Form & Consent to Treat
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
Medical Record Request–Self or Legal Guardian
Consent to Disclose Verbal Health Information
Advance Directive Information and Form
Translated Materials
🌐 Forms are available in the languages listed below.
Patient Registration Form
العربية (Arabic) | Français (French) | नेपाली (Nepali) | Soomaali (Somali) | Español (Spanish) | Kiswahili (Swahili) | Tiếng Việt (Vietnamese)
Medical/Dental History Form
العربية (Arabic) | မြန်မာ (Burmese) | دری (Dari) | नेपाली (Nepali) | پښتو (Pashto) | Soomaali (Somali) | Tiếng Việt (Vietnamese)
School-Based Dental Center Medical/Dental History Form
العربية (Arabic) | Français (French) | नेपाली (Nepali) | Soomaali (Somali) | Español (Spanish) | Kiswahili (Swahili) | Tiếng Việt (Vietnamese)
Consent to Disclose Health Information
العربية (Arabic) | Français (French) | नेपाली (Nepali) | Soomaali (Somali) | Español (Spanish) | Kiswahili (Swahili) | Tiếng Việt (Vietnamese)
Consent to Disclose Verbal Health Information
العربية (Arabic) | Français (French) | नेपाली (Nepali) | Soomaali (Somali) | Español (Spanish) | Kiswahili (Swahili) | Tiếng Việt (Vietnamese)
Medical Records Request – Self or Legal Guardian
العربية (Arabic) | Français (French) | नेपाली (Nepali) | Soomaali (Somali) | Español (Spanish) | Kiswahili (Swahili) | Tiếng Việt (Vietnamese)
Sliding-Fee Scale Application
العربية (Arabic) | Français (French) | नेपाली (Nepali) | Soomaali (Somali) | Español (Spanish) | Tiếng Việt (Vietnamese)
Patient Rights and Responsibilities Brochure
العربية (Arabic) | မြန်မာ (Burmese) | नेपाली (Nepali) | Soomaali (Somali) | Tiếng Việt (Vietnamese)
Notice of Privacy Practices
العربية (Arabic) | Français (French) | नेपाली (Nepali) | Soomaali (Somali) | Español (Spanish) | Kiswahili (Swahili) | Tiếng Việt (Vietnamese)
Dr. Dynasaur Health Coverage Info
العربية (Arabic) | မြန်မာ (Burmese) | 中文 (Mandarin) | नेपाली (Nepali) | Soomaali (Somali) | Tiếng Việt (Vietnamese)