Consent to Disclose Personal Health Information (PHI)
Form and recommendations for obtaining consent to disclose patient health information to a third party.
Consultation for Dental Treatment
Form for a mutual patient’s physician to confirm medical condition, diagnosis and/or fitness for treatment
Dental History
Form for capturing a patient’s at-home oral hygiene, dental concerns and treatment history
Diagnostic X-rays Required Letter
Sample letter to inform and educate a patient of necessary X-rays to continue dental treatment
Dispensing Products Acknowledgment
Form to document products that are dispensed to a patient (does not apply to medications)
Emergency Phone Screening to Determine Appointment Immediacy
Form to facilitate patient screening by phone and determine immediacy, appointment need or emergency care
Esthetic Approval (Crowns, Veneers, Bridges)
Form for esthetic approval of crowns, veneers or bridges
Esthetic Approval and Case Completion (Dentures and Partials)
Form for esthetic approval of dentures or partials and permission to proceed with their completion
Failed Appointments Letter
Sample letter to a patient who continues to miss dental appointments to address needs and consequences
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