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*** The email function on the Spanish  form is currently unavailable. This form must be printed and returned to our office or your child's school.

School contacts please use the link below for double sided printing.

How To:


1. Click on the appropriate download link below (English or Spanish)
2. The form will automatically download for completion or printing when you click the link.
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. 


*** To complete the form on your mobile device you will need the free Adobe Fill and Sign app. This can be found in your app store or by following the links below.

Apple: https://itunes.apple.com/us/app/adobe-fill-sign/id950099951?mt=8
Android: https://play.google.com/store/apps/details?id=com.adobe.fas&hl=en_US

Below you will find links to our Health and Consent form. This form is required before we can provide any services at school and public health sites and must be updated annually.

The Health and Consent form must be filled out completely including a parent or guardian signature and date. 

The Health and Consent form is  available in a PDF format to be completed and signed electronically and emailed to our office. It may be also be downloaded and printed, then returned to our office or your child's school office.