KOHA Forms

The following KOHA forms should be sent to parents/caregivers before the start of the school year, or as close to the beginning of the school year as possible. 

The kindergarten registration packet is usually prepared by district-level staff the year before the current school year, and KOHA forms should be included in this packet. Please work with district staff to determine whether KOHA forms were included in the kindergarten registration packet. If not, please work with LOHP and district staff to ensure KOHA forms are included in the kindergarten registration packet, and send the KOHA forms out to all parents/ caregivers of Kindergartners as soon as possible.

KOHA form distribution opportunities include kindergarten orientation, back-to-school registration packets, and back-to-school nights.

Say hello to the KOHA forms!


Parent Notification Letter - describes what the KOHA requirement is and what parents/caregivers need to do. It includes information about how to access dental care in the county, as well as basic oral health information.

Parent Notification Letter

Kindergarten Oral Health Assessment Form – the screening/assessment form parents/caregivers need to take to their child’s dental appointment and have the dental provider complete. If the child’s school hosts a KOHA screening day, the dental providers will complete this required form there.


Waiver of the KOHA Requirement - if children do not yet have a dentist or dental insurance, cannot easily get to a dentist, do not attend a school hosting an on-site KOHA screening event, or their parent/caregiver does not believe they would benefit from the assessment, a waiver form may be completed. However, if parents/caregivers need further assistance to complete the KOHA, they are encouraged to contact their school health staff or Local Oral Health Program.

KOHA Waiver

On-Site Screening Opt-Out Letter - (For schools hosting on-site screenings) this letter ideally only goes to parents/caregivers of students at schools receiving on-site screenings and is a way they can let schools know they would not like to have their child receive the free on-site oral health screening. If this letter is included in the KOHA forms packet for schools that do not host on-site screenings, parents/ caregivers may confuse it with the KOHA waiver form.

At School Onsite Opt-out Screening Letter

The KOHA screening results letter for parents/caregivers is an additional site-specific form for on-site KOHA screenings. It is completed by the dental provider for each child receiving an on-site school oral health screening. It is sent home to parents/caregivers and includes information about the basic findings and any next steps needed.

See a sample screening results letter in English and sample letter in Spanish.