BMedicalb Clearance for Dental Treatment - Audubon Dental Group 2026

1. Click ‘Get Form’ to open it in the editor.
2. Begin by entering the date at the top of the form. This helps keep track of when the clearance is issued.
3. Fill in the patient's name and birthdate in the designated fields to ensure accurate identification.
4. Address the letter to the appropriate doctor by filling in their name after 'Dear Dr.'
5. Check off all applicable treatment options that the patient is scheduled for, such as cleaning, fillings, or extractions.
6. Indicate any medical conditions by checking 'Yes' or 'No' for antibiotic prophylaxis and anesthetic restrictions.
7. Provide details on anticoagulant interruption and specify how long before and after treatment this should occur.
8. Complete any additional comments or recommendations regarding medications as necessary.
9. Ensure that the physician's name is printed clearly, followed by their signature and date at the bottom of the form.

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