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Patient Forms
Contact us
- 850-689-5593
- Okaloosa-Dental@flhealth.gov
-
Fax
850-689-5928 -
Mailing Address
810 James Lee Blvd.
Crestview, FL 32539
Please print and complete the forms with your child’s information. You will need to bring the forms and a photo ID to your child’s first appointment.
Due to HIPAA regulations, please do not e-mail forms to the clinic.
New Patient Forms (English) (PDF 1005KB)
New Patient Forms (Spanish) (PDF 1MB)
Notice of Privacy Practices (Spanish) (PDF 2MB)
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