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 [PDF, 675.37 KB]

Ellensburg Dental Registration Form – Spanish [PDF, 532.83 KB]

Discounted Fee Application- English [PDF, 432.71 KB]

Discounted Fee Application – Spanish [PDF, 450.56 KB]

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

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