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The HealthCare Connection
  • 1401 Steffen Ave, Cincinnati, OH 45215
  • (513) 588-3623
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Patient Forms

Authorization to Release Information  Click Here

Minor by Proxy Consent Form with Notary Click Here

Permission to Communicate Health Information Click Here

Autorización Para Divulgar Informacion Clic Aquí

La Autorización Para El Tratamiento de Los Menores –
Consentimiento Por Representacion Clic Aquí

Permiso Para Comunicar Información Protejeda de Salud Clic Aquí

Dental Patient Forms

Dental History & Information  Click Here

Post Filling Child AfterCare  Click Here

Post Oral Surgery AfterCare  Click Here

Historia Dental y Información Clic Aquí

Después del llenado Cuidado Clic Aquí

Cirugía Oral posterior Cuidado  Clic Aquí

Viking School-Based Health Center Information & Forms

Viking School-Based Health Center FAQs   Click Here

Covid-19 Vaccine Save the Date for 16 & 17-year olds   Click Here

Patient Rights and Privacy Practices

Notice of Privacy Practice Click Here

Notificación de Prácticas de Privacidad Clic Aquí

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