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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 Caretaker to Accompany a Minor

Sample authorization for a non-legal guardian to accompany a minor patient to dental appointments

Consent to Disclose Personal Health Information (PHI)

Form and recommendations for obtaining consent to disclose patient health information to a third party.

Dispensing Products Acknowledgment

Form to document products that are dispensed to a patient (does not apply to medications)

Informed Consent Declaration: Minor Patient

Form for a non-legal guardian to authorize dental treatment on a minor patient

Office Closure Checklist

A checklist to help minimize property damage, secure the premise and protect assets during a closure.

Patient Dismissal Letter

Contact a Risk Management Advice Line analyst for one-on-one support with a patient dismissal letter

Premises Incident Report

Form for documenting injuries involving patients or visitors inside or outside the practice

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Access a dentistry-focused risk management articles, guides, sample letters, informed consent forms and more.