Mailing address:​



Phone:

Fax:

If you have questions feel free to call our office at 507-529-0436 or use the "Contact Us" page.

HOW TO: 

1. Click on the appropriate download link below (English or Spanish)
2. Once the link opens you click the download button in the upper right corner
3. Open the downloaded document with the free Adobe Reader (if you don't have Adobe Reader, you can get it here free!)
4. Fill out the entire form and save it. (Remember where you saved it!)
5. Return the form to our office via email (office@twentyteeth.org) and be sure to attach the saved form. Be sure it is e-signed if returning via email. You can also print, sign and mail it to the address below or fax it to us.  

Forms

Below you will find our Health and Consent form. This form is required before we can provide any services and must be filled out completely including a parent signature and date. This form is required to be signed annually, please remember to fill it out each year. It is available in an easy to download and print PDF format. 

The download button (Step 2):

School Contacts, please use the link below for two-sided printing:

903 West Center Street, Suite #130
Rochester, MN 55902 


(507) 529-0436      
(507) 529-0435