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Patient Forms

ºÚÁÏ³Ô¹Ï Dental Clinic patients have the option to print the following forms to complete before their appointment.

Photo of students working with patients in dental clinic

Please call the clinic at 812-464-1706 to schedule your appointment before sending these forms. These forms may be returned via mail, fax or email and must be received at least one business day prior to the appointment.

Mail:
ºÚÁÏ³Ô¹Ï Dental Clinic
Health Professions Center
8600 University Boulevard
Evansville, IN 47712

Fax: 812-461-5352

Email: dental.programs@usi.edu

Please call the ºÚÁÏ³Ô¹Ï Dental Clinic at 812-464-1706 if you would like these forms mailed to you.

Connect With
ºÚÁÏ³Ô¹Ï Dental Clinic

(812) 464-1706