Form Templates by SpurrFamilyDentistry

Dental Treatment Waiver

A dental treatment waiver is a document used by medical practices to obtain patient consent before treating them.

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Dental Patient Information Form

This Dental Patient Information Form allows new patients to enrol your database by providing their personal and contact information, dental insurance details, health information with further details.

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Dental Health History Form

A dental health history form collects information about a patient’s dental health and medical history.

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X-Ray Refusal Form

This is an informed refusal to exam and/or X-rays that provides your patients with the refusal terms and asks for their signature and consent.

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Missed Appointment Policy Acknowledgement Form

Missed Appointment Policy Acknowledgement Form provides your patients with the policy that will be carried out in case of an appointment miss and asks for their acknowledgment.

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Medical Record Release Request Form

This Medical Record Release Request Form allows your patients to request the transfer of their medical records.

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Root Canal Therapy Consent Form

Root Canal Therapy Consent Form provides your patients with the treatment terms and asks for their consent and approval.

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Oral Treatment Acceptance Form

This is an oral treatment acceptance form that provides your patients with the treatment terms and price and asks for their acceptance.

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Oral and Maxillofacial Surgery Consent Form

This Oral and Maxillofacial Surgery Consent Form provides your patients with the procedural information and terms and asks for their approval.

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Pre-Appointment Wellness Form

This Pre-Appointment Wellness Form is to be filled out by your patients before their visit to your clinic that asks questions regarding the coronavirus.

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