Release of Medical Information

River Valley Health & Dental is committed to providing quality, inclusive care. Ensuring we have as much information as possible prior to your first visit is very important. Please make sure this Release of Information is filled out entirely before submitting. If you have any questions regarding this form, please call us at (570) 567-5400. Once we receive this form, we will contact you to schedule your new patient appointment!

Attention – Pediatric Patients!

Scheduling of new pediatric patient appointments is on hold pending the recruitment of a new pediatric provider. All other new patient appointment will continue as normal.