Notice, acknowledgement/release and policy to inform patients and staff that surveillance cameras are in use
Sample authorization for a non-legal guardian to accompany a minor patient to dental appointments
Form for a patient to authorize release of records to another dentist, physician or authorized representative
Full set of CBCT sample forms, including informed consent, refusal, referral and notice of non-read scan
Updated
Form and recommendations for obtaining consent to disclose patient health information to a third party.
Form for a mutual patient’s physician to confirm medical condition, diagnosis and/or fitness for treatment
Form for capturing a patient’s at-home oral hygiene, dental concerns and treatment history
Updated
Sample letter to inform and educate a patient of necessary X-rays for comprehensive care.
Form to document products that are dispensed to a patient (does not apply to medications)