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Ellensburg Dental Care

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DENTAL CARE FORMS

The Ellensburg Dental Care forms on this page are provided in Adobe PDF format, please download the form(s) you need, fill it in and return it.

If you need Adobe Reader to open the forms you can download it here.

Please ask a member of our Reception Team for assistance!

Ellensburg Dental Registration Form – English

Ellensburg Dental Registration Form – Spanish

Discounted Fee Application- English

Discounted Fee Application – Spanish

Authorization for Ellensburg Dental Care to use or disclose my Dental Information – English

Authorization for Ellensburg Dental Care to use or disclose my Dental Information – Spanish

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Contact

  • Yakima CWFM
  • Yakima Pediatrics
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  • Ellensburg Dental
  • Highland Clinic
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FTCA Notice

Community Health of Central Washington receives medical malpractice coverage provided by the Federal Tort Claims Act (FTCA).

Community Health of Central Washington recibe cobertura de negligencia medica proporcionada por la Ley Federal de Demandas por Ofensas (FTCA).

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