Dental health record downloadable form: Fill out & sign online

Here's how it works

01. Edit your dental health record downloadable form online

Type text, add images, blackout confidential details, add comments, highlights and more.

02. Sign it in a few clicks

Draw your signature, type it, upload its image, or use your mobile device as a signature pad.

03. Share your form with others

Send loan indemnity agreement via email, link, or fax. You can also download it, export it or print it out.

How to use or fill out DENTAL HEALTH RECORD with our platform

Ease of Setup

DocHub User Ratings on G2

Ease of Use

DocHub User Ratings on G2

Click ‘Get Form’ to open the DENTAL HEALTH RECORD in the editor.
Begin by entering the child's name and date of birth (DOB) at the top of the form. Select the appropriate gender and center.
Fill in the parent or guardian's name, phone number, and address to ensure accurate contact information.
Provide your authorization by signing in the designated area, confirming that you allow qualified individuals to exchange information about your child.
In the table provided, list any recommended services along with details such as tooth number, surfaces treated, date of service, and a description of services performed.
Indicate any oral conditions before treatment using the diagram provided. Mark missing teeth, decay, or filled areas as applicable.
Complete the CHILD ORAL HEALTH SUMMARY section by checking off dental needs and problems noted. Specify if all planned treatments are complete or not.
Finally, return completed forms to the parent/guardian or send them to SETA Head Start as instructed at the bottom of the form.

Start filling out your DENTAL HEALTH RECORD online for free today!

See more DENTAL HEALTH RECORD versions

We've got more versions of the DENTAL HEALTH RECORD form. Select the right DENTAL HEALTH RECORD version from the list and start editing it straight away!

Versions	Form popularity	Fillable & printable
2018	4.2 Satisfied (57 Votes)
2015	4 Satisfied (54 Votes)
2012	4.7 Satisfied (63 Votes)

be ready to get more

Complete this form in 5 minutes or less

Get form

Got questions?

We have answers to the most popular questions from our customers. If you can't find an answer to your question, please contact us.

Contact us

What is a dental health record?

The dental record is your official document that details all diagnostic information, health history, clinical notes, treatment performed, and patient-related communications that took place in the practice.

What does a dental record look like?

Dental records, also known as patient charts, are made up of the recorded information regarding your medical history, diagnostic information, clinical notes, patient-doctor communication, consent to treatment documents and treatment notes, as the American Dental Association (ADA) explains.

How does a dental record work?

What happens during a dental check-up? At each check-up, your dentist should: examine your teeth, gums and mouth. ask about your general health and any problems youve had with your teeth, mouth or gums since your last visit. ask about, and give you advice on, your diet, smoking and alcohol use, and teeth-cleaning

What is a dental health check?

A dental record is the detailed document of the history of the illness, physical examination, diagnosis, treatment, and management of a patient. Dental professionals are compelled by law to produce and maintain adequate patient records.

dental record form pdf

Dental records example How to obtain dental records Free printable dental health History forms School dental form pa Dental health History forms PDF Dental documentation guidelines Pa school DENTAL HEALTH RECORD Dental records database