Patient Application

as of december, 2024, we are unable to accept applications for dental services.

In order to be seen at Harmony Health Clinic, please download and print the patient application, fill it out, and bring it to the office. Once you have submitted your application, it will be reviewed and we’ll reach out to you.  You may also pick up an application at the clinic, call us at (501) 375-4400, or email our Clinic Manager, Connie, at connie@harmonyclinicar.org to request that we mail an application to you.

Click here to download a Patient Application in English

Click here to download a Patient Application en Espanol

Notice of Privacy Practices

You may download a copy of our current Notice of Privacy Practices below. You may also pick up a copy at the clinic, call us at (501) 375-4400, or email our Clinic Manager, Connie at connie@harmonyclinicar.org to request a copy.

Click here to download a copy of our Notice of Privacy Practices in English

Click here to download a copy of our Notice of Privacy Practices en Espanol