A new Health and Consent form is required annually to be seen at our school-based and public health clinics.
The form must be completed, including a parent or guardian's signature and date.
The Health and Consent form is available in PDF format. You can print it and return it to our office or your child's school office.
1. Click on the appropriate download link below (English, Spanish or Somali)
2. When you click the link, The form will automatically download.
3. Open the downloaded document with the free Adobe Reader (if you don't have Adobe Reader, you can follow the link below to get it free!)
*** Forms will not print properly using Google Docs ***
4. Print, sign, and return it to your child's school or mail to 903 W Center Street, STE 130, Rochester, MN 55902
Children's Dental Health Services
United Way Building, 903 West Center Street Suite #130 Rochester, MN 55902 Community Action Building, 105 1st Street SE, Austin, MN 55912
Copyright © 2019 Children's Dental Health Services - All Rights Reserved.
Powered by GoDaddy Website Builder
We use cookies to analyze website traffic and optimize your website experience. By accepting our use of cookies, your data will be aggregated with all other user data.