Forms

Grinovations is a mobile dental clinic working with our local Health Department to bring convenient, inexpensive, preventive dental services into your school. Research proves that most dental problems are easily prevented. Please encourage your child to participate. A Registered Dental Hygienist will if needed, provide a screening, oral hygiene instructions, cleaning, preventive plastic sealants, and fluoride varnish. We will inform parents of all findings and help families locate a dentist if needed. We do come back for a second time within the school year to check the child’s sealants for retention and to complete another cleaning and fluoride.

The Heath Insurance Portability and Accountability Act 1996 (HIPAA) requires all health care records to be kept confidential. Grinovations adheres to all HIPAA standards, and will provide our Notice of Privacy Practices to all patients at their first appointment.

Our Rates:

  • Screenings – $15.00
  • Cleaning – $30.00
  • Fluoride Varnish – $20.00
  • Sealants (if needed) – $30.00 each *

* (Normally 4 are needed at age 6, and another 4 at age 11 or 12, and guaranteed through High School)

Consent Forms for Parents

Download form, complete, attach copies of insurance and return to your child’s school before or during our visit.

Grinovations Initial Form-Spanish

Grinovations Initial Form-English

Evaluation form 2014

Evaluation form Spanish 2014

 

For Tacoma School District Use Only:

Grinovations Initial Form-English Tacoma

Grinovations Intitial Form-Spanish Tacoma