Dental Care Forms

Patient Portal

Mountain Health Center’s patient portal promotes better communication with your provider by offering a secure, convenient way to manage your personal health care.

Patient Forms

New Patients (You will need to complete one of each):

  1. Patient Registration Form
  2. Dental Questionnaire
  3. Policy/Welcome Form
  4. Billing Agreement
  5. Communication Consent Form
  6. Uniform Consent Form
  7. Sliding Fee Scale Application

Download our Dental Care Brochure (2019)

Sliding Fee Discount:

Are you eligible to receive up to a 40% to 90% discount for medical care and 20% – 80% discount on basic dental care?

Mountain Health Center and Mountain Health Dental Care offers a Sliding Fee Discount Program. Eligibility is purely income dependent and does not require health insurance nor does it matter what company health insurance you have.

Ready to apply? Applications are available in office or click on the link below.

Download our Sliding Fee Discount Program Application