Are there patient forms I can fill out before my visit?
- 2023 Child Registration Form (English)
- 2023 Child Registration Form (Spanish)
- 2023 Adult Registration Form (English)
- 2023 Adult Registration Form (Spanish)
- Medical Dental History Form (English)
- Medical Dental History Form (Spanish)
- Acknowledgement of Privacy Practices (English)
- Acknowledgement of Privacy Practices (Spanish)
- Consent of Minor (English)
- Consent of Minor (Spanish)
- Uninsured Patient Application (English)
- Uninsured Patient Application (Spanish)
What is the referral process?
- Please complete the Agency Referral Form. Provide as much information about the patient as possible.
- Fax referral form to our Waukesha clinic at fax number 262-522-2828 OR our Menomonee Falls at fax Number 262-502-0508.
- For all questions pertaining to a referral, please call the clinic you faxed your referral to.
- Patients will be scheduled for appointments by the Community Smiles Dental staff after eligibility is confirmed.
- OB/GYN medical providers should use our OB/GYN Referral Form. to refer pregnant patients to our clinics
What is your Snow Day policy?
Our clinic policy is to cancel clinic for the day when the Waukesha Public Schools and Menomonee Falls Public Schools close due to inclement winter weather. If your child has an appointment and school is cancelled for the day, please note that your child's dental appointment will also be cancelled. We will call you to reschedule as soon as we have a make up day plan.
New this year, we will not call you to tell you your appointment is cancelled. You can verify that the clinic is closed by visiting our Facebook page, looking for us on your local news TV station snow closing listing OR by calling and our clinic voicemail will confirm our closing for you.
Updated Sliding Fee Scale for Uninsured Patients July 2023
To make an appointment, please call the clinic at 262-522-7645.
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