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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 Agent to Consent to Dental Treatment of a Minor

Sample care authorization for an adult to whom care of a minor has been entrusted.

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.

Caregiver's Authorization Affidavit

Form for a caregiver to authorize a minor’s enrollment in school-related or other medical care. 

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

Diagnostic X-rays Are Required Letter

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

Employee Informed Refusal of Post Exposure Medical Evaluation

A form for employers to document an employee’s informed refusal of a medical evaluation following exposure to...

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