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Enrollment Form NEW HMONG

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Enrollment Form NEW HMONGbbsmiles2024-08-20T11:10:35-05:00
  • Qhia txog tus menyuas - Thov siv lub npe raug cai

  • MM slash DD slash YYYY
  • Qhia Txog niam txiv - Thov siv lub npe raug cai

  • Qhia txog koj li ntawv kho mob

    *(Ped tsi txais ntawv kho nhiav tom haujlwm). Cov nyiaj tau los ntawm koj tus account FSA/HSA yuav raug siv los ua ib daim ntawv them nyiaj, thov nrog koj tus neeg nqa khoom saib xyuas cov ntsiab lus tshwj xeeb.
  • Txhua tus menyuam kawm ntawv uas tsis muaj tsev neeg kws kho hniav raug txais tos tuaj rau npe. Yog tias koj tsis muaj BadgerCare/ForwardHealth, cov kev pabcuam tiv thaiv yuav raug pub dawb rau koj tus menyuam kawm ntawv. Yog xav paub ntxiv thov hu rau Bridging Brighter Smiles.
    *(Ped tsi txais ntawv kho nhiav tom haujlwm). Cov nyiaj tau los ntawm koj tus account FSA/HSA yuav raug siv los ua ib daim ntawv them nyiaj, thov nrog koj tus neeg nqa khoom saib xyuas cov ntsiab lus tshwj xeeb.
  • Nhias ntawm no mus nyeem txog Bridging Brighter Smile li txoj kev pab thiab nqi.
  • Menyuas kawm ntawv li keeb kwm txog kev noj qab nyob zoo

  • Kev Tso cai

  • Nyem qhov no kom paub txog kev kho hniav x-rays. Kuv tso cai tias yuav muab x-rays tshiab.
  • Nia ntawm nov mus nyeem Bridging Brighter Smiles Inc’s dlaim ntawv qhia txog tias qhov uas peb xyaus tsi pub lwm tug paub zoo li cas. Kuv nyeem thiab tobtaub hais tais kuv yuav tau txais ib dlaim ntawv no ntawm Bridging Brighter Smiles Inc.’s website ntawm http://bridgingbrightersmiles.org/forms/, lossis hu mus nrog tug neeg ua haujlwm ntawm lub tsev kawm uas Bridging Brighter Smiles muab kev pab.
  • Sau npe hauv no mus

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