This form is required for:
( Kindergarten, 3rd grade, 7th grade, 11th grade or if they are new to the school )
 
To request a completed Commonwealth of Pennsylvania Department of Health – Private Dentist Report of Dental Examination, your child must have been seen at our office for an exam within the past 12 months. If your child is due for a visit, please call us to schedule an appointment before submitting this form request.
Please see attached the Pennsylvania School Dental form, fill it out and send it back to us via email. At [email protected] and please put on the email subject request of dental form. 

School forms are completed by our office 48 business hours upon receival. Forms will be sent in PDF format to the email address you send it from.