Head Start Oral Health Form - Children 2026

1. Click ‘Get Form’ to open the Head Start Oral Health Form - Children in the editor.
2. Begin by entering the child's name, date of birth, and address in the Patient Information section. Ensure accuracy for effective communication.
3. Indicate whether this practice is the child’s dental home by selecting 'Yes' or 'No'. Fill in the parent’s/guardian’s name and phone number next.
4. In the Current Oral Health Status section, answer questions regarding untreated decay and previous treatments by selecting 'Yes' or 'No' as applicable.
5. For Oral Health Care Services Delivered During Visit, check all relevant services provided during the visit, including examinations and cleanings.
6. Complete the Future Oral Health Care Services section by indicating if all treatment is completed and providing details on any future appointments needed.
7. Finally, fill out the Oral Health Provider’s Contact Information and Signature section with the provider's details before saving your form.

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