Forms

The welcome letter and three brief forms will get you registered for treatment in advance of your first appointment. Please read them, complete them and bring them with you, or mail them to help us get your account set up and speed up the process for you.

• Please read our welcome letter before completing forms. Welcome Letter for New Patients
• Next, tell us about you:
  • Adult 18+ Patient Information Form
  • Pediatric Registration Form
• We’ll need this form to get your consent to treat you: Consent to Treat Form
• We’ll need this to gather information about your health history: Authorization to Release Healthcare Info

We want you to be aware of your rights, choices and how we use and share your health information:
Notice of Privacy Practices https://www.chcrr.org/privacy-notice/

The welcome letter and four brief forms will get you registered for treatment in advance of your first appointment. Please read them, complete them and bring them with you, mail them or fax them to help us get your account set up and speed up the process for you.

• Please read our welcome letter before completing forms. Welcome Letter for New Patients
• Next, tell us about you: Dental Registration Sheet
• We’ll need some health history from you:  Dental Patient History
• We’ll need this form for consent to treat you: Dental Consent to Treat
• We’ll need this to gather information about your dental history: Dental Authorization to Release Healthcare Info

We want you to be aware of your rights, choices and how we use and share your health information:
Notice of Privacy Practices https://www.chcrr.org/privacy-notice/

To fill the form out online please click on the button below:

To fill out a PDF and email:

1. 1. Download the form below to your desktop by clicking on the link under Step #5.
   2. Open with Adobe Acrobat.
   3. Fill out the form.
   4. Save it.
   5. Castleton University COVID Testing Registration Form

Email the completed form to:
patientportal@chcrr.org
or fax to: 802-772-7973