FAQ

Are there patient forms I can fill out before my visit?

• Child Registration Form (English)
• Child Registration Form (Spanish)
• Adult Registration Form (English)
• 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

Updated Sliding Fee Scale for Uninsured Patients 2025

2025 CSD Patient Letter – Updated Sliding Fee Scale (English)

2025 CSD Patient Letter – Updated Sliding Fee Scale (Spanish)

To make an appointment, please call the clinic at 262-522-7645.