Miracle Dental Associates
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Miracle Dental

Online Consent Form

Child Information

Thank you for choosing Miracle Dental to take care of your child’s teeth. Simply complete this easy step-by-step permission form.

By doing so, a state licensed hygienist and dentist will regularly check your child's mouth & teeth, as well as provide a cleaning, x-rays as necessary, fluoride treatment and apply sealants, as needed. Additional care, such as fillings, may also be provided. A dental report card will be sent home with your child. By completing this, the dentist will be able to see your child for their initial and check-up exams.