Program Forms

Washington State Smile Partners is required to obtain parent or guardian consent before treating a child.

To make sure you child receives care, print out the form below, fill it out, and turn in to the front office at your child’s school or pre-school center.

Parent consent forms

Want to find out if Smile Partners visits your child’s school or pre-school site? Contact us today.


The Heath Insurance Portability and Accountability Act 1996 (HIPAA) requires all health care records to be kept confidential. Smile Partners adheres to all HIPAA standards, and will provide our Notice of Privacy Practices to all patients.