Forms
Important School of Dentistry Forms
Forms are available in Somali, English, Spanish, Russia, Hmong, Amharic and Vietnamese. For more information, please call 612-625-2495.
English language forms
English language forms
Registration Form
Adult Health History Form
Child Health History Form
- Release of Records
- Driving Directions
- Patient Bill of Rights
CBCT Referral Form
- COVID-19 Clinical Intake (done at Moos Tower)
Spanish language forms (Formularios en español)
Spanish language forms (Formularios en español)
Registration Form (Formulario de registro del paciente)
Adult Health History Form (Cuestionario médico y dental)
Child Health History Form (Formulario de historia médica pediátrica)
Release of Records Form (Revelación de expedientes)
Driving Directions Form (Direcciones al edificio de estacionamiento)
Patient Bill of Rights (Derechos y responsabilidades del paciente)
COVID-19 Clinical Intake Form (Formulario de triaje de COVID-19)
Russian language forms (Русскоязычные формы)
Russian language forms (Русскоязычные формы)
Registration Form (СТОМАТОЛОГИЧЕСКАЯ КЛИНИКА)
Adult Health History Form (Вопросы о медицинских и стоматологических проблемах)
Child Health History Form ИСТОРИЯ БОЛЕЗНИ (ПЕДИАТРИЯ)
Release of Records Form (ВЫДАЧА ЗАПИСЕЙ)
Driving Directions Form (ПАРКОВОЧНАЯ ПЛОЩАДКА НА WASHINGTON AVENUE)
Patient Bill of Rights (Права и обязанности пациента)
COVID-19 Clinical Intake Form (ФОРМА ОПРОСА В СВЯЗИ С COVID‐19)
Hmong language forms (Cov ntawv Hmoob)
Hmong language forms (Cov ntawv Hmoob)
Registration Form (DAIM NTAWV SAU NPE NEEG MOB)
Adult Health History Form (Lus Nug Txog Kev Kho Hniav thiab Kev Kho Mob)
Child Health History Form (DAIM FOOS SAU KEEB KWM ME NYUAM YAUS KEV NOJ QAB HAUS HUV)
Release of Records Form (NTHUAV TAWM NTAUB NTAWV SAU TSEG)
Driving Directions Form (THOV COJ RAWS LI COV LUS QHIA NO MUS RAU)
Patient Bill of Rights (Neeg Mob Cov Kev Muaj Cai thiab Cov Luag Hauj Lwm)
COVID-19 Clinical Intake Form (DAIM FOOS COVID‐19 PEB CEG)
Amharic language forms (የአማርኛ ቋንቋ ቅጾች)
Amharic language forms (የአማርኛ ቋንቋ ቅጾች)
Registration Form (የታካሚ ምዝገባ ቅጽ – የጥርስ ክሊኒኮች)
Adult Health History Form (የሜዲካል እና የጥርስ ሕክምና መጠይቅ)
Child Health History Form (የሕፃናት ጤና አጠባበቅ ታሪክ ቅፅ)
Release of Records Form (የመረጃዎች መለቀቅ)
Driving Directions Form (እባክዎ እነዚህን መመሪያዎች ለጥርስ ህክምና ትምህርት ቤት የመኪና ማቆሚያ ራምፕ ይከተሉ)
Patient Bill of Rights (የታካሚ መብቶች እና ግዴታዎች)
COVID-19 Clinical Intake Form (የCOVID‐19 የሙከራ ቅፅ)
Vietnamese language forms (Hình thức ngôn ngữ tiếng việt)
Vietnamese language forms (Hình thức ngôn ngữ tiếng việt)
Registration Form (BIỂU MẪU ĐĂNG KÝ BỆNH NHÂN)
Adult Health History Form (Bảng Câu Hỏi Về Y Tế và Nha Khoa)
Child Health History Form (BIỂU MẪU BỆNH SỬ NHI KHOA)
Release of Records Form (TIẾT LỘ HỒ SƠ)
Driving Directions Form (VUI LÒNG TUÂN THEO CÁC HƯỚNG DẪN NÀY DÀNH CHO BÃI ĐỖ XE DENTAL SCHOOL)
Patient Bill of Rights (Quyền và Trách Nhiệm Của Bệnh Nhân)
COVID-19 Clinical Intake Form (BIỂU MẪU SÀNG LỌC COVID‐19)
Somali language forms (foomamka af-soomaaliga)
Somali language forms (foomamka af-soomaaliga)
Registration Form (XARUMAHA CAAFIMAADKA ILKAHA)
Adult Health History Form (Foomka Su'aalaha Caafimaadka Ilkaha)
Child Health History Form (FOOMKA TAARIIKHDA CAAFIMAADKA CARRUURTA)
Release of Records Form (SHAACINTA DIIWAANNADA)
Driving Directions Form (FADLAN RAAC TILMAAMAHAAN SI AAD U GASHO AAGA BAAKINKA EE KULIYADA CAAFIMAADKA ILKAHA)
Patient Bill of Rights (Xaquuqaha iyo Waajibaadka saaran Bukaanka)
COVID-19 Clinical Intake Form (FOOMKA SADDEX GEESOODKA EE COVID‐19)