Forms

Silver Diamine Fluoride Consent Form

Lexanna Kocher2023-07-11T14:56:21-05:00

Silver Diamine Fluoride Consent FormLexanna Kocher2023-07-11T14:56:21-05:00

2023-2024 School Consent Form

Lexanna Kocher2023-07-11T14:39:05-05:00

This allows your child to be seen in the school.

2023-2024 School Consent FormLexanna Kocher2023-07-11T14:39:05-05:00

Public Health Dental Hygienist Agreement Form

Lexanna Kocher2023-07-07T11:42:19-05:00

Public Health Dental Hygienist Agreement FormLexanna Kocher2023-07-07T11:42:19-05:00

Release of Medical Records Form

Lexanna Kocher2023-07-07T11:40:47-05:00

Release of Medical Records FormLexanna Kocher2023-07-07T11:40:47-05:00

Authorization Non-Parent/Guardian to Accompany Patient Form

Lexanna Kocher2023-07-07T11:39:30-05:00

Authorization Non-Parent/Guardian to Accompany Patient FormLexanna Kocher2023-07-07T11:39:30-05:00

State Exam Form

Lexanna Kocher2023-07-12T11:14:01-05:00

This form is required for students entering Kindergarten, 2nd grade, 6th grade, and 9th grade. Return to the Edgar County Public Health Department or the child's school.

State Exam FormLexanna Kocher2023-07-12T11:14:01-05:00

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