Failed Appointments Letter Sample letter to a patient who continues to miss dental appointments to address needs and consequences October 23, 2015 Sample Forms Alaska Arizona California Hawaii Idaho Illinois Minnesota Montana Nevada New Jersey North Dakota Oregon Pennsylvania Tennessee Washington Documentation General Liability
Follow Up for Biopsy Letter Sample letter to a patient about referral for evaluation and/or biopsy of a suspicious area or lesion October 24, 2018 Sample Forms Alaska Arizona California Hawaii Idaho Illinois Minnesota Montana Nevada New Jersey North Dakota Oregon Pennsylvania Tennessee Washington Documentation Patient Care
Health History Sample form for capturing a patient's health concerns and medical history October 23, 2015 Sample Forms Alaska Arizona California Hawaii Idaho Illinois Minnesota Montana Nevada New Jersey North Dakota Oregon Pennsylvania Tennessee Washington Topic Documentation General Liability Patient Care
Image Release Form for a patient's consent and liability release for the practice to use their photos and videos October 23, 2015 Sample Forms Alaska Arizona California Hawaii Idaho Illinois Minnesota Montana Nevada New Jersey North Dakota Oregon Pennsylvania Tennessee Washington Documentation General Liability
Informed Consent Declaration: Minor Patient Form for a non-legal guardian to authorize dental treatment on a minor patient August 08, 2023 Sample Forms State Washington Topic Documentation Patient Care
Office Closure Checklist A checklist to help minimize property damage, secure the premise and protect assets during a closure. April 12, 2024 Sample Forms State Alaska Arizona California Hawaii Idaho Illinois Minnesota Montana Nevada New Jersey North Dakota Oregon Pennsylvania Tennessee Washington General Liability
Orthodontic Forms Set A full set of sample forms: early removal of braces, lack of progress and statement of satisfaction March 03, 2020 Sample Forms Alaska Arizona California Hawaii Idaho Illinois Minnesota Montana Nevada New Jersey North Dakota Oregon Pennsylvania Tennessee Washington Documentation Patient Care
Patient Dismissal Letter Contact a Risk Management Advice Line analyst for one-on-one support with a patient dismissal letter February 08, 2017 Sample Forms State Alaska Arizona California Hawaii Idaho Illinois Minnesota Montana Nevada New Jersey North Dakota Oregon Pennsylvania Tennessee Washington
Premises Incident Report Form for documenting injuries involving patients or visitors inside or outside the practice May 03, 2024 Sample Forms State Alaska Arizona California Hawaii Idaho Illinois Minnesota Montana Nevada New Jersey North Dakota Oregon Pennsylvania Tennessee Washington Documentation General Liability
Referral Letters (set of three) A set of sample letters for referring a patient, referral replies or findings and a patient summary October 23, 2015 Sample Forms Alaska Arizona California Hawaii Idaho Illinois Minnesota Montana Nevada New Jersey North Dakota Oregon Pennsylvania Tennessee Washington Documentation General Liability Patient Care