Oral Health Assessment Request Form - Modesto City Schools 2026

1. Click ‘Get Form’ to open the Oral Health Assessment Request Form in the editor.
2. Begin by filling out Section 1, which requires details about your child. Enter their first name, last name, middle initial, birth date, address, city, ZIP code, and gender. Ensure all fields are completed accurately.
3. Next, provide the school name and teacher's name along with your child's grade. This information helps the school maintain accurate records.
4. Complete the race/ethnicity section by selecting the appropriate option that best describes your child.
5. Once your child has had their dental assessment, Section 2 must be filled out by the dental professional. They will indicate any visible caries or fillings and recommend treatment urgency.
6. Finally, ensure that the dental professional signs and dates this section before submitting it back to the school.

Start using our platform today to easily complete and submit your Oral Health Assessment Request Form for free!