Forms

COVID Vaccine Registration Form

Patient Registration

Family Health of Darke County - Treat a Minor consent updated

Patient Screening Questions

PRAPARE Annual Exam

Medicare Wellness Packet

Pediatric Dentistry

Consent for Dental Treatment Minor

Additional History Minor - Dental

Patient Registration

Parent Information About Behavior Management Tech for Child Dental

Family Health of Darke County - Treat a Minor consent updated

Member of the Ohio Association of Community Health Centers

This health center receives HHS funding and has Federal Public Health Service (PHS) deemed status with respect to certain health or health related claims. This includes medical malpractice claims for Family Health and its staff. Family Health is protected by the Federal Tort Claim Act Program (FTCA).

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