Patient Forms Click below to Print Out Registration, Health History, & HIPAA Consent Forms. Completed forms may be submitted via email or fax…. Email: 1mobilehygienist@gmail.com Fax: 619-434-6288 Patient Consent for Treatment PATIENT CONSENT FOR TREATMENT FORM – CLEANING WITH LOVE Patient Health and Dental PATIENT HEALTH AND DENTAL HISTORY – CLEANING WITH LOVE If your are a Medi-Cal/Denti-Cal patient, please scan a copy or take a picture of your Medi-Cal card Email: 1mobilehygienist@gmail.com or Fax: (619) 434-6288. If you’re not sure what your Medi-Cal card looks like, scroll down and look at this flyer. MEdi-Cal ID flyer (1)
