Knox County Tennessee

Forms and Fact Sheets

For Parents

Consent form/Medical History En Espanol
– Print, complete, and return to school if you want your child to participate in the sealant program. Here is a list of participating schools.

Report of Dental Inspection En Espanol
– You will receive a report that looks like this with the dentist’s findings from your child’s screening or exam.

Silver Diamine Fluoride Reports
–Your child will receive a report with the dentist's findings from your child's screening or exam. Your child will also receive another report if silver diamine fluoride was applied. Silver diamine fluoride is a liquid placed on a cavity that kills bacteria and strengthens that part of the tooth.
SDF Treatment Report in English and Spanish

Sealant Fact Sheet En Espanol
– Dental sealants are thin plastic coatings that are painted on the chewing surfaces of back teeth in order to help prevent cavities. More info is available in the fact sheet above.

For more information, contact the Knox County School-Based Dental Prevention Program, at, or by phone at 865-215-5773.

Have Questions?
Call: 865-215-5555

Need to report a public
health emergency?

Call 865-215-5093

On the first Wednesday of every month, all KCHD offices and clinics are closed in the morning for staff in-service. On these days, the main location (140 Dameron Ave.) will open at 11 a.m. and the West Clinic (1028 Old Cedar Bluff) will open at 11:30 a.m.

Clinics will also open at 10:30 a.m. (Main location) and 11 a.m. (West Clinic) on the following Wednesdays: April 17 and July 17. All other offices will open at 8 a.m.