Dental Forms

COVID-19

Whiteside COVID Information

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Folder Dental Forms

pdf Dental Clinic Medical History

Download (pdf, 114 KB)

Dental History 2017.pdf

pdf HIPAA Notice acknowledgement

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HIPAA Notice acknowledgement.pdf

pdf Non-Covered Services Agreement

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Non-Covered Services Agreement.pdf

pdf Patient Information Form

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Patient Information 2017.pdf

pdf Verification of Income and Family Size

Download (pdf, 481 KB)

Documented Verification of Income Family Size - English - 2018 (1-24-2018) (1).pdf

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Whiteside Health News

Vaccinating Phase 1A Press Release

Written on Tue, January 01, 2021
New Job Opening - Full Time Network Technician

Written on Mon, October 10, 2020
Behavioral Health Job Posting

Written on Thu, September 09, 2020
Volunteers Needed!!

Written on Thu, December 12, 2019

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