Health History (English)- Health History (Spanish)
- School Based Permission Form (English)
- School Based Permission Form (Spanish)
- Consent Form (English)
- Consent Form (Spanish)
Forms
Brown County Oral Health Partnership complies with all applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex.
We Speak Your Language
English 
العربية 
简体中文 
Filipino 
Français 
Deutsch 
हिन्दी 
Hmong 
한국어 
ພາສາລາວ 
Polski 
Русский 
Afsoomaali 
Español 
Tiếng Việt
We will take reasonable steps to provide free-of-charge language assistance services to people who speak the languages we are likely to hear in our practice and who don’t speak English well enough to talk to us about the dental care we are providing.
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