top of page
806 Commerce Dr. Suite B
Decorah, IA | 52101
​
Telephone: 563.382.6259
Fax: 563.538.0100
Text: 563.202.7168
forms
​
Current patients: We require all active patients to update their Health History and acknowledge our most recent privacy notices every 3 years. If informed by our staff that you are due to complete this, please print, complete, and bring both the "HIPAA Update" and "Health History Update" forms to your child's next appointment. For multiple children, please complete a health history form for each child. Only one HIPAA form is required, as you can list multiple children on that document.
HIPAA Update
Health History Update
​
​
Parents of Kindergarteners/Freshman: Is your child going to be in kindergarten or a freshman this next academic year? If so, the state of Iowa requires all kindergarteners & 9th graders have a dental exam. You can find the form below.
Kindergarten/Freshman Screening
​
bottom of page