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Click ‘Get Form’ to open the RK CAA HEAD START PROGRAM DENTAL HISTORY bb - rkcaa in the editor.
Begin by entering the child's name and date of birth in the designated fields at the top of the form.
In the Dental History section, answer whether there have been any previous dental problems by selecting 'YES' or 'NO'. If 'YES', provide a brief explanation in the space provided.
Continue by indicating if your child has experienced any bleeding, chewing, or swallowing problems. Again, select 'YES' or 'NO' and explain if necessary.
Fill out whether your child has previously seen a dentist and include the date of service if applicable.
Answer questions regarding topical fluoride application, fluoridated water, and supplements by selecting 'YES' or 'NO' for each item.
If your child is under a physician's care, provide the physician’s name; otherwise, select 'NONE'.
The Dental Examination section will be completed by a dentist. Ensure that all necessary information is filled out accurately during their visit.

Start using our platform today to easily complete and manage your dental history forms for free!

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