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Call: 517-740-7422 (Lower)
Call: 906-282-8741 (UP)
Kindergarten Assessments: 517-867-3582
Fax: 517-315-4918
Email: [email protected]
KOHA Email: [email protected]

1715 Lansing Avenue, Room 261
Jackson, Michigan 49202

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Forms

Adult Clinic

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Dental Sealant

  • Consent Form - English
  • Dental Sealant Flyer - English
  • Dental Sealant Flyer- Spanish
  • Dental Sealant Flyer - Arabic

Fluoride Varnish

  • Varnish Consent Form - English
  • Varnish Consent Form - Spanish

HIPAA

  • HIPAA Policy
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