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.

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Case Completion and Esthetic Approval

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

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Sample Forms Alaska Arizona California Hawaii Idaho Illinois Minnesota Montana Nevada New Jersey North Dakota Oregon Pennsylvania Tennessee Washington Documentation General Liability Patient Care

Consultation for Dental Treatment

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

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Sample Forms Alaska Arizona California Hawaii Idaho Illinois Minnesota Montana Nevada New Jersey North Dakota Oregon Pennsylvania Tennessee Washington Documentation General Liability Patient Care

Dental History Form

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

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Sample Forms Alaska Arizona California Hawaii Idaho Illinois Minnesota Montana Nevada New Jersey North Dakota Oregon Pennsylvania Tennessee Washington Documentation Patient Care

Diagnostic X-rays Are Required Letter

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

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Sample Forms Alaska Arizona California Hawaii Idaho Illinois Minnesota Montana Nevada New Jersey North Dakota Oregon Pennsylvania Tennessee Washington Documentation General Liability Patient Care

Dispensing Products Acknowledgment form

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

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Sample Forms State Alaska Arizona California Hawaii Idaho Illinois Minnesota Montana Nevada New Jersey North Dakota Oregon Pennsylvania Tennessee Washington General Liability Patient Care

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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Sample Forms Alaska Arizona California Hawaii Idaho Illinois Minnesota Montana Nevada New Jersey North Dakota Oregon Pennsylvania Tennessee Washington Documentation Patient Care

Esthetic Approval

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

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Sample Forms Alaska Arizona California Hawaii Idaho Illinois Minnesota Montana Nevada New Jersey North Dakota Oregon Pennsylvania Tennessee Washington Documentation General Liability Patient Care

Failed Appointments Sample Letter

Sample letter to patient who continues to miss dental appointments to address needs and consequences.

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Sample Forms Alaska Arizona California Hawaii Idaho Illinois Minnesota Montana Nevada New Jersey North Dakota Oregon Pennsylvania Tennessee Washington Documentation General Liability

Health History

Sample form for capturing a patient’s general health, conditions, allergies, medications, medical concerns and...

Sample Forms Alaska Arizona California Hawaii Idaho Illinois Minnesota Montana Nevada New Jersey North Dakota Oregon Pennsylvania Tennessee Washington Documentation Patient Care

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