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Family Health Services
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Forms

Forms

COVID Vaccine Registration Form
COVID Vaccine Registration Form
Patient Registration Form
Patient Registration
Family Health of Darke County - Treat a Minor consent updated
Family Health of Darke County - Treat a Minor consent updated
Patient Screening Questions
Patient Screening Questions
PRAPARE Annual Exam
PRAPARE Annual Exam
Medicare Wellness Packet
Medicare Wellness Packet

Pediatric Dentistry

Consent for Dental Treatment Minor
Consent for Dental Treatment Minor
Additional History Minor - Dental
Additional History Minor - Dental
Patient Registration
Patient Registration
Parent Information About Behavior Management Tech for Child Dental
Parent Information About Behavior Management Tech for Child Dental
Family Health of Darke County - Treat a Minor consent updated
Family Health of Darke County - Treat a Minor consent updated
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Community Health Center
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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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