FORMS

PATIENT FORMS

In an effort to provide the best service possible, you can fill out your patient form before coming to your appointment. Click the images below to open the Child or Adult form. You can either print it out and fill it out by hand, or you may also enter your information directly into the PDF on your computer, click submit and it will be emailed to our office.

Some fields are required. Thank you for your cooperation!

OUR COMMITMENT TO PRIVACY

Your privacy is important to us. When visiting our office, you will be provided a notice explaining our privacy practices and the choices you can make about the way your information is collected and used.

Physical Address:

Community Health Center
108 Michigan Avenue West 
Walker, MN 56484  

Mailing Address:

PO Box 1389 

Walker, MN 56484 

Phone, Fax & Email:

(218) 547-1851 

Fax: (218) 547-2261 

info@pedersonfamilydental.com

Connect With Us:
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We accept the following payment types & insurance:

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