New Patient Registration Form (Medical)

New Patient Registration Forms (Dental)

• New Patient Registration
• Dental Medical History
• Consent for Treatment
• New Patient Registration (Spanish)
• Dental Medical History (Spanish)
• Consent for Treatment (Spanish)

Statement of Zero income

• 2025 Statement of Zero income (english)
• 2025 Statement of Zero income (spanish)

Letter of Support

• 2025 Letter of Support (english)
• 2025 Letter of Support (spanish)

Sliding Fee Discount Policy & Application

• 2025 Statement of Zero income (english)
• 2025 Statement of Zero income (spanish)

School Based Telehealth Form (English)

School Based Telehealth Form (Spanish)