Forms

Click on the buttons below to download our new patient forms.

• Spirit Lake Early Childhood Tracking Health History (PDF)
• Fluoride Consent (PDF)
• Childhood Lead Poisoning Evaluation Questionnaire (PDF)
• Screening Checklist for Contraindications to Vaccines for Children and Teens (PDF)
• Patient's Rights & Responsibilities (PDF)
• Authorization To Furnish Information and Assignment Of Benefits (PDF)
• NDHSAA Sports Physical Form (PDF)
• Spirit Lake Early Childhood Tracking New Infant/Child Application Ages 0 to 5 year (PDF)
• Screening Checklist for Contraindications to Live Attenuated Intranasal Influenza Vaccination (PDF)
• Screening Checklist for Contraindications to Injectable Influenza Vaccination (PDF)
• Education New Client Application (PDF)
• Education Growth & Development Agreement (PDF)
• Education Program Authorization for the Release of Records (PDF)