Thank you for choosing Toothbud for your child's / children's dental home. This form needs to be completed for each child being seen as a patient at Toothbud. All information in this form is confidential and transmitted over a secure, encrypted connection and will not be sold to any third party.
Tell Us About Your Child
DISCLAIMER: By typing your name below, you are signing this application electronically. You agree that your electronic signature is the legal equivalent of your manual signature on this application.