Public Forms

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Public Forms for Download

Attention Parent Letter (Download: English)
Permission Slip (Download: English or Español or Français or Polski)
County specific Permission Slips

CPS/Cook County (Download: English or Español or Polski)
CPS/Cook Take Home (Download: English)
CPS/Norwegian Dental Van restorative consent forms (Download: English)
Knox County (Download: English or Français or Español or Polski)
Sangamon County (Download: English)
Will County (Download: English or Español or Polski )

Restorative Consent (Download: English or Español)
Restorative Consent Springfield area (Download: English or Español)
MOS Exam Form (Download: English)
Take Home (Download: English or Español or Français)
State Mandated Exam Form (Download: English)
HIPPA compliance (Download: English)
Fluoride Varnish disclaimer regarding tree nut allergies (Download: English)

©2017 Miles of Smiles, Ltd. All Rights Reserved
2424 N 8th St, Pekin, IL 61554-1574
Phone: 309-382-6404 Fax: 309-382-6405