Dental Forms Library

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I. Consent Forms:

English: Authorization for Anesthesia; Dental Hygiene; Endodontic Treatment; Extraction of Teeth 1; Extraction of Teeth 2; Nitrous Oxide; Parental Consent; Patient Mgmt Techniques; Pediatric Dentistry; Perform Dentistry; Photos/Video Tapes Release; Post-Op for Extractions; Root Canal; Special Procedures Consent; Treatment by Extern Dentist; Treatment by Student

Spanish: Anestesia; Cirujia Oral; Endodoncia; Extraccion; Oxido Nitroso; Procedimientos Especiales; Tratamiento Dental

II. Refusal Forms: X-Ray Refusal

III. Excuse Letters: Excuse Letter

IV. Consultation Requests: Consultation Request; Medical Consultation Request

Financial:

English: Fee Estimate; Financial Policy; Payer Types; The Superbill

Spanish: Reglamentos Financieros

Emergencies: Dental Emergencies; Emergencies; Fire Safety; Medical Emergencies; Pain/Trauma

Records: Records Management

Miscellaneous:

English: Appointment Cancel/Reschedule; Child's Appointment; Dental Clinic Policies; Dental Radiology; General Information; Medical Referrals; Patient Management Techniques; Patient Rights & Responsibilities; Policy; Professional Nuggets; ALARA Program

Spanish: Cancelada; Informacion Referente; Necessitamos; Poliza

English: Encounter Form; Health History Form; Initial Patient Contact; Medical History Form; Patient Info Sheet;

Spanish: Historia de Salud; Initial Patient Contact

English: Care after Extraction; Extraction Precautions; Instructions for Patients Who Receive IV Sedation; Local Anesthesia; Oral Surgery Instruction; Procedure Form

Spanish: Extracion Precausiones; Instucciones Cirujia

VIII. New Provider Information:

CHC History/Facilities/Services/Programs/Staff; Credentialing Requirements; Credentials Package; Health Status Questions; Privilege Request Form; Release of Information for Professional Competence/Training; Welcome to CHC Clinic

IX. Education Materials:

For Patients:

English: Baby's Mouth; Care for Teeth; Diabetes/English; Diabetes/Oral Health 1; Diabetes/Oral Health 2; Facts on Diabetes; Mouth Cancer; Patient Emergencies; Plaque & Tartar; Pregnancy/Oral Health

Spanish: Bebe Boca; Cancer de la Boca; Cuidar Dientes; Diabetes/Dental; Embarazo/Oral;
Placa y el Sarro

For Providers:

Acetaminophen; Dental Access; Dental Issues; Dental Progs; Diabetes; Oral Health; Pediatric Dosing; Pregnant Patient

X. Miscellaneous:

Dental Equipment Maintenance Log; Levin Group Order Form; OSHA Material Safety Data Sheet; US Army Pregnancy and Postpartum Training