Patient cleaning 2026

1. Click ‘Get Form’ to open the patient cleaning document in the editor.
2. Begin by entering the child's name and date of birth in the designated fields. Ensure accuracy for proper identification.
3. Fill in the parent’s or guardian’s name, phone number, and address details including city, state, and zip code.
4. Indicate whether this practice is the child’s dental home by selecting 'Yes' or 'No'.
5. For current oral health status, answer questions regarding untreated decay and previous treatments by selecting 'Yes' or 'No' as applicable.
6. In the section for oral health care services delivered during the visit, check all relevant services provided such as examinations, x-rays, and cleanings.
7. Complete any additional information required for future appointments and provider contact details at the end of the form.

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