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J. Thomas Russell, DDS

    General Dentist
    1030 Xenia Avenue,PO Box 839
    Yellow Springs, Ohio
    937.767.7731 
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Univ Florida Dental Forms

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    screeningForm.pdf

     (947K)
    Print form and fill out completely Fax completed form to 352.273.7484 - OR - Mail completed form to: UFCD Dental Records/Screening P.O. Box 100425 Gainesville, FL 32610-0425 Screening staff will contact you soon with an appointment. We will attempt to contact you for 2 months after which you will need to re-apply. If you are unable to print or fax the form, call 352.273.5251 or (toll free) 1.800.633.3953 opt. 4._____________________________________________________ To See the webpages that describe the services available at the University of Florida School of Dentistry Dental Clinics: FOR COMPLETE INSTRUCTIONS AND LOCATIONS of clinics_enter this URL address --- http://www.soundentistry.com/univ-florida-dental-clinic/