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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