Kids Forms

Our teams of profesional dentist, hygienist and site coordinators go into schools to offer preventative dental services to low-income children.

Clinics

Tooth decay is the most common chronic childhood disease, affecting nearly six out of ten children by third grade. Children from low-income homes can have three times the number of cavities as their peers. Yet, the majority of children in disadvantaged households in Washington state do not receive dental care. Most children from low-income families do not have dental insurance.

 

What you need to do?

Fill out the forms in your suitable language and return it to your child's school before or during our visit. You can download the form below or you can request a form by contacting us.

Parent consent forms

YOUR INFORMATION, YOUR RIGHTS


The Heath Insurance Portability and Accountability Act 1996 (HIPAA) requires all health care records to be kept confidential. Smile Partners adheres to all HIPAA standards, and will provide our Notice of Privacy Practices to all patients.