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New Patient Registration — Dental

Welcome to Community Health —
Where Your Health is Our Mission!

Community Health serves all patients regardless of income or insurance status. Our sliding fee program allows us to reduce or “slide” the fees for the care of you and your family. If you need assistance paying for your care, a front office assistant can answer questions and provide a sliding fee application or you can print one off of our website. Eligibility for this program is based on family size and income. Find out how to apply.

A discount is also provided if you have no insurance or if you pay in full on date of service. See a front office assistant for more information about the discount percentages.

Before your first visit, please read and complete:

These documents help us become familiar with your health history, current treatments and medications, as well as your immediate health needs and concerns.

Return completed forms to:

Community Health Medical Records
71 Allen Street, Suite 402, Rutland, VT 05701

Please remember to bring a copy of your current medications to your first appointment. We’re excited that you’ve chosen to receive your care with us. Thank you!

We want you to be aware of your rights, choices and how we use and share your health information:
Notice of Privacy Practices

TitleCategoriesLink
Dental Records Release Authorization Form,
Download
New Dental Patient — Consent to Treat
Download
New Dental Patient — Health History Form
Download
New Dental Patient — Registration Form
Download