Follow the steps to successfully complete the form

1. Click ‘Get Form’ button to access the online form and open it for editing.
2. Begin by entering your child's name and nickname in the designated fields.
3. Fill in the address, city, and zip code to provide complete contact information.
4. Provide your child's birth date and select their gender from the options provided.
5. Enter the home phone number and email address for communication.
6. List the names, birth dates, employers, and cell phone numbers of both parents.
7. Indicate whether your child has any allergies or is taking any medications, providing details as necessary.
8. If applicable, describe any issues encountered at birth and detail your child's developmental status.
9. In the insurance information section, include the insured person's name, date of birth, social security number, employer, insurance carrier, and identify who has legal custody of the patient.
10. Provide information on how you learned about the academy.
11. Detail your child's health history by listing the child's physician, preferred pharmacy, and any relevant medical history.
12. Assess and indicate your child's dental health importance and current evaluation on a scale of 1-10.
13. Document any previous unpleasant experiences with dental care and last dental visits.
14. Beside treatment consent, authorize dental care for your child and note any individuals permitted to accompany your child to appointments.
15. After reviewing the information, save your changes, download the form, print it, or share it as needed.

We encourage you to complete your documents online for a smoother experience.