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Consent Forms & Documentation
CMOHS is please to provide Oral Health services to our patients and the agencies we work with. We are making available our consent forms and other documentation for patients and agencies to download at thier convenience. Please contact us if you encounter any problems downloading our forms.
CMOHS consent form Parent consent form brochure.
CMOHS/Tufts University consent form Consent form brochure for CMOHS and Tufts dental partnership program.
CMOHS/Boston Public Schools consent formConsent form brochure for CMOHS and the Boston Public School dental partnership program.
CMOHS/BEST Oral Health consent formConsent form brochure for CMOHS and Springfield B.E.S.T dental partnership program.
CMOHS HIPPA Policy Patient HIPPA policy document
BEST HIPPA PolicyPatient HIPPA policy document for CMOHS and Springfield B.E.S.T dental partnership program.
Acknowledge of CMOHS Privacy PolicyAcknowledge form that patient recieved prvacy policy
Record Release Authorization Authorization Form for releasing Patient Dental Record.
Extraction Consent Form Patient consent form for tooth extraction procedure
Pre-Medication Notification FormPatient notification of subscribed medication
CMOHS Parents LetterWelcome letter to parents explaining the services offered by CMOHS
B.E.S.T Parents Letter. Progress report letter to parents explaining their childs progress in regards to the oral health plan.
B.E.S.T Enrollment Letter.Welcome letter to parents explaining the services offered by CMOHS and Springfield B.E.S.T dental partner program.