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Consent Forms

How to get started?

It's easy and convenient! Each child must have a parent fill out and sign a consent form. Please download, fill out, and bring to the dental cleaning. 

How much does it cost?

Mobile Smiles' services are 100% covered by most insurances, including Medicaid. 

Mobile Smiles Consent Form (English) >

Mobile Smiles Consent Form (Spanish) >

Fluoride Varnish Consent Form (English) >

Fluoride Varnish Consent Form (Spanish) >

Basic Dental Screening (English) >

Basic Dental Screening (Spanish) >

Fluoride Varnish Info (English) >

Fluoride Varnish Info (Spanish) >

Post Op Fluoride Varnish Instructions (English) >

Post Op Fluoride Varnish Instructions (Spanish) >

Quality

Mobile

Dental Care

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