Please print and fill out these forms so we can expedite your first visit:
- Patient Information Form - Adult (age 18+)
- Patient Information Form - Child (age 18 under)
- HIPPA forms ** PLEASE COMPLETE PAGES 3 & 4 AND BRING TO YOUR APPOINTMENT
“Your Smile Can Make A Difference Scholarship”
The Hartland Smilemakers philosophy of serving others finds its roots in people. It is the goal of Dr. Ken, Dr. Chris and Dr. Joel to assist in the health of their patients, but this is only the first step. Working in and with community groups over the years (Boy Scouts, Hartland Area Jaycees, HAYAA, Gleaners Community Food Bank and more) they have tried to make a difference. Making a difference is essential if our community, our state, and our nation is to remain strong. The youth are the world’s future today and tomorrow.
The “Your Smile Can Make A Difference” Scholarship is meant to encourage you to start thinking about making a difference—an easy, first step is your smile.
We are proud of you as a high school senior and feel honored to be part of your family’s health team. Please take the time to think about making a difference and write down those thoughts while applying for our scholarship. Please find the criteria and deadlines in the following page.
Thanks- Smiles Make a Difference,
Dr. Ken, Dr. Chris, Dr. Joel & The Smilemaker Team