Oral Health
Consent Form

Please complete this form to provide consent for your child's dental care through our school oral health program.

Estimated Time

3–5 Minutes

Who Should Complete?

Parent / Guardian

Need Ready

Medicare Card (Optional)

Child Information

Parent Information

Medical Information

Medicare Information

Consent

Review & Submit

Step 1 of 617%

Child Information

Child's Information

Please provide your child's basic details before continuing.

Title*

First Name*

Middle Name

Last Name*

Gender*

Date of Birth*

Before you continue

Please ensure the child's name and date of birth match their Medicare card or other official documents. Incorrect information may delay processing of your consent form.

Step 1 of 6

Oral HealthConsent Form

3–5 Minutes

Parent / Guardian

Medicare Card (Optional)

Child Information

Child's Information

Before you continue

Oral Health
Consent Form