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Sample Forms

We’re here to make record keeping easier and more efficient so you can better protect your practice. View, download and customize the right resources for your state. Find sample forms and letters to support documentation, employment, general liability and patient care.

Authorization for Care-taker to Accompany a Minor

Sample form to authorize a non-legal guardian to accompany a minor patient to dental appointments.

Authorization for Release of Dental Records

Form for patient to authorize release of records to another dentist, physician or authorized representative.

Case Completion and Esthetic Approval

Sample form for esthetic approval of dentures or partials and permission to proceed with their completion

CBCT Scan Forms

Set of CBCT sample forms, including informed consent, refusal, referral and notice of non-read scan.

Consultation for Dental Treatment

Form for mutual patient’s physician to confirm medical condition, diagnosis and/or fitness for dental treatment

Dental History Form

Sample form for capturing a patient’s at-home oral hygiene, dental concerns and treatment history.

Diagnostic X-rays Are Required Letter

Sample letter to inform and educate a patient of necessary X-rays to continue dental treatment.

Dispensing Products Acknowledgment form

Sample acknowledgment form to document products dispensed to a patient. Does not apply to medications.

Emergency Phone Screening to Determine Appointment Immediacy

Form to facilitate patient screening by phone and determine immediacy or appointment or emergency care.

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Explore More Resources

Access a dentistry-focused risk management articles, guides, sample letters, informed consent forms and more.