Consent & Release Forms

You may download, print, and complete the appropriate forms before your appointment at any Whitefoord Health Center.

  • Adult Medical Consent
  • Pediatric Medical Consent
  • Teen Medical Consent
  • New Dental Patient - All Ages
  • Medical History Release

You may print and fill out the following consent and intake forms to expedite the check-in process. CLICK HERE

Adult Patient Consent April 2017

You may print and fill out the following consent and intake forms to expedite the check-in process. CLICK HERE

Pediatric Consent Form

You may print and fill out the following consent and intake forms to expedite the check-in process. CLICK HERE

Teen Consent Form April 2017

You may print and fill out the following consent and intake forms to expedite the check-in process. CLICK HERE

Dental Clinics Intake form

If you are being referred from an outside facility or would like to send any medical records to Whitefoord, you may print and fill out the following form and bring it with you to your next visit to Whitefoord. CLICK HERE

 

Authorization of Release of Records Form