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Forms and Samples - California |
| Forms and Samples | |
| Allergy Labels | Download PDF (94K) |
| Authorization for Agent to Consent to Dental Treatment of a Minor - California | Download PDF (43K) |
| Authorization for Release of Dental Records - California | Download PDF (24K) |
| Caregiver’s Authorization Affidavit - California | Download PDF (51K) |
| Compromised Personal Information Letter | Download PDF (8K) |
| Confidential Health History | Download PDF (15K) |
| Diagnostic X-rays Are Required in Order to Continue Doctor-Patient Relationship | Download PDF (8K) |
| Documentation of Self-Sufficient Minor Status - California | Download PDF (7K) |
| Emergency Telephone Screening to Determine Appointment
Immediacy |
Download PDF (19K) |
| Failed Appointments Sample Letter | Download PDF (9K) |
| Fax Transmission to Physician Requesting Medical Clearance for Dental Treatment | Download PDF (12K) |
| Fen-Phen Alert! | Download PDF (71K) |
| Forgiving Balance Form | Download PDF (11K) |
| Initial Screening Consent Form | Download PDF (8K) |
| Photograph Authorization | Download PDF (8K) |
| Referring Patient for Evaluation and/or Treatment (Sample Letter) | Download PDF (13K) |
| Summary of Findings and/or Treatment (Sample Letter) | Download PDF (7K) |
| Refusal to Consent to Treatment | Download PDF (8K) |
| Informed Consent | |
| Guidelines For Use of Informed Consent - California | Download PDF (23K) |
| Anesthesia/Sedation | Download PDF (46K) |
| Apicoectomy Treatment | Download PDF (29K) |
| Behavior Management | Download PDF (23K) |
| Informed Consent Template | Download PDF (16K) |
| Crowns | Download PDF (57K) |
| Dentures | Download PDF (30K) |
| Extraction | Download PDF (24K) |
| Implant Informed Consents for Surgical and Restorative Treatment (2 separate forms) | Download PDF (115K) |
| Non-Surgical Periodontal Treatment | Download PDF (23K) |
| Orthodontic Treatment | Download PDF (39K) |
| Root Canal Treatment | Download PDF (24K) |
| Surgical Periodontal Treatment | Download PDF (24K) |
| Tooth Whitening (Bleaching) | Download PDF (22K) |
| Veneers | Download PDF (18K) |
| Informed Consent — Spanish | |
| Guidelines For Use of Spanish Informed Consent - California | Download PDF (25K) |
| Anesthesia/Sedation | Download PDF (28K) |
| Apicoectomy Treatment | Download PDF (29K) |
| Behavior Management | Download PDF (36K) |
| Crowns | Download PDF (26K) |
| Dentures | Download PDF (30K) |
| Extractions | Download PDF (28K) |
| Implant Informed Consents for Surgical and Restorative Treatment (2 separate forms) | Download PDF (124K) |
| Initial Screening Consent Form | Download PDF (9K) |
| Non-Surgical Periodontal Treatment | Download PDF (26K) |
| Orthodontic Treatment | Download PDF (39K) |
| Root Canal Treatment | Download PDF (29K) |
| Surgical Periodontal Treatment | Download PDF (24K) |
| Tooth Whitening (Bleaching) | Download PDF (22K) |
| Veneers | Download PDF (18K) |
| Informed Consent — Chinese | |
| Guidelines For Use of Chinese Informed Consent - California | Download PDF (24K) |
| Anesthesia/Sedation | Download PDF (137K) |
| Apicoectomy Treatment | Download PDF (106K) |
| Behavior Management | Download PDF (121K) |
| Crowns | Download PDF (117K) |
| Dentures | Download PDF (125K) |
| Extractions | Download PDF (121K) |
| Implant Informed Consents for Surgical and Restorative Treatment (2 separate forms) | Download PDF (400K) |
| Non-Surgical Periodontal Treatment | Download PDF (121K) |
| Orthodontic Treatment | Download PDF (157K) |
| Root Canal Treatment | Download PDF (104K) |
| Surgical Periodontal Treatment | Download PDF (129K) |
| Tooth Whitening (Bleaching) | Download PDF (91K) |
| Veneers | Download PDF (103K) |
| Informed Consent — Traditional Chinese | |
| Guidelines For Use of Traditional Chinese Informed Consent - California | Download PDF (24K) |
| Anesthesia/Sedation | Download PDF (137K) |
| Apicoectomy Treatment | Download PDF (106K) |
| Behavior Management | Download PDF (121K) |
| Crowns | Download PDF (117K) |
| Dentures | Download PDF (125K) |
| Extractions | Download PDF (121K) |
| Implant Informed Consents for Surgical and Restorative Treatment (2 separate forms) | Download PDF (378K) |
| Non-Surgical Periodontal Treatment | Download PDF (121K) |
| Orthodontic Treatment | Download PDF (157K) |
| Root Canal Treatment | Download PDF (104K) |
| Surgical Periodontal Treatment | Download PDF (129K) |
| Tooth Whitening (Bleaching) | Download PDF (91K) |
| Veneers | Download PDF (103K) |
| Informed Consent — Korean | |
| Guidelines For Use of Korean Informed Consent - California | Download PDF (24K) |
| Anesthesia/Sedation | Download PDF (223K) |
| Apicoectomy Treatment | Download PDF (195K) |
| Behavior Management | Download PDF (203K) |
| Crowns | Download PDF (199K) |
| Dentures | Download PDF (125K) |
| Extractions | Download PDF (343K) |
| Implant Informed Consents for Surgical and Restorative Treatment (2 separate forms) | Download PDF (500K) |
| Non-Surgical Periodontal Treatment | Download PDF (205K) |
| Orthodontic Treatment | Download PDF (280K) |
| Root Canal Treatment | Download PDF (211K) |
| Surgical Periodontal Treatment | Download PDF (216K) |
| Tooth Whitening (Bleaching) | Download PDF (162K) |
| Veneers | Download PDF (188K) |
| Informed Consent — Russian | |
| Guidelines For Use of Russian Informed Consent - California | Download PDF (24K) |
| Anesthesia/Sedation | Download PDF (137K) |
| Apicoectomy Treatment | Download PDF (106K) |
| Behavior Management | Download PDF (121K) |
| Crowns | Download PDF (117K) |
| Dentures | Download PDF (125K) |
| Extractions | Download PDF (121K) |
| Implant Informed Consents for Surgical and Restorative Treatment (2 separate forms) | Download PDF (378K) |
| Non-Surgical Periodontal Treatment | Download PDF (121K) |
| Orthodontic Treatment | Download PDF (157K) |
| Root Canal Treatment | Download PDF (104K) |
| Surgical Periodontal Treatment | Download PDF (129K) |
| Tooth Whitening (Bleaching) | Download PDF (91K) |
| Veneers | Download PDF (103K) |
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