Sample Forms

Take advantage of our sample documents — such as allergy warnings, health history and letters — by using them in your dental office.


Authorization for Release of Dental Records Content Type - Sample Form, State, North Dakota

Authorization for Release of Dental Records Content Type - Sample Form, State, Pennsylvania

Caregiver's Authorization Affidavit Content Type - Sample Form, State, California

Case Completion and Esthetic Approval Content Type - Sample Form, State, Alaska, Arizona, California, Hawaii, Illinois, Minnesota, Nevada, New Jersey, North Dakota, Pennsylvania

CBCT Scan Forms Content Type - Sample Form, State, Alaska, Arizona, California, Hawaii, Illinois, Minnesota, Nevada, New Jersey, North Dakota, Pennsylvania

Compromised Personal Information Letter Content Type - Sample Form, State, Alaska, Arizona, California, Hawaii, Illinois, Minnesota, Nevada, New Jersey, North Dakota, Pennsylvania

Consent to Dental Screening Content Type - Sample Form, State, Alaska

Consent to Dental Screening Content Type - Sample Form, State, Arizona, California, Hawaii, Minnesota, Nevada, New Jersey, North Dakota, Pennsylvania

Consent to Dental Screening Content Type - Sample Form, State, Illinois

Consultation for Dental Treatment - UPDATED Content Type - Sample Form, State, Alaska, Arizona, California, Hawaii, Illinois, Minnesota, Nevada, New Jersey, North Dakota, Pennsylvania

Dental History Form Content Type - Sample Form, State, Alaska, Arizona, California, Hawaii, Illinois, Minnesota, Nevada, New Jersey, North Dakota, Pennsylvania

Diagnostic X-rays Are Required Letter Content Type - Sample Form, State, Alaska, Arizona, California, Hawaii, Illinois, Minnesota, Nevada, New Jersey, North Dakota, Pennsylvania

Emergency Telephone Screening Form Content Type - Sample Form, State, Alaska, Arizona, California, Hawaii, Illinois, Minnesota, Nevada, New Jersey, North Dakota, Pennsylvania

Employee Informed Refusal of Post Exposure Medical Evaluation Content Type - Sample Form, State, Alaska, Arizona, California, Hawaii, Illinois, Minnesota, Nevada, New Jersey, North Dakota, Pennsylvania

Esthetic Approval Content Type - Sample Form, State, Alaska, Arizona, California, Hawaii, Illinois, Minnesota, Nevada, New Jersey, North Dakota, Pennsylvania

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