Below you will find a link to our on-line consent form. This form needs to be completed by a parent or guardian and submitted prior to your child's visit.  Please call us at 866-916-6447 if you have any questions or need help completing this form. 

 

NOTE: The e-sign process needs to be confirmed through your email before it is complete.

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Maryland

• Baltimore Consent Form

• Cecil Consent Form

• Prince George Consent Form

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Pennsylvania

• Philadelphia Consent Form

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Watch & Brush

Try using these fun two minute videos to keep your kids brushing for 2 whole minutes twice a day.