Templates Health & Wellness Medical Dental Health Assessment Form Template

Dental Health Assessment Form Template

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Personal Information

Dental History

Lifestyle and Habits

Consent and Signature

Consent for Treatment
Clear Signature

The Dental Health Assessment Form Template by WPForms helps dental clinics and professionals simplify patient intake through a straightforward form that collects all important dental health and appointment details.

How Does the Dental Health Assessment Form Template Work?

The Dental Health Assessment Form Template requires the WPForms Pro License and the Signature Addon to capture patient details and obtain consent for any dental treatments beforehand. Fields include:

  • Personal Information:
    • Patient Name: Know who’s stepping into your dental world.
    • Date of Birth: Crucial for understanding patient demographics.
    • Contact Number: For those times when you need to reach out swiftly.
    • Email Address: Ideal for sending appointment confirmations and dental tips.
  • Dental History:
    • Reason for Visit: Helps tailor the patient’s experience from the get-go.
    • Date of Last Visit: Insight into patient’s dental care regularity.
    • Previous Dentist: For a better understanding of patient’s dental history.
    • Dental Conditions: Knowing existing conditions helps in planning ahead.
    • Dental Treatments: A look into past procedures for comprehensive care.
  • Lifestyle and Habits:
    • Dietary Habits: Because what we eat affects our dental health significantly.
    • Smoking / Tobacco Use: Essential for assessing risk factors.
    • Alcohol Consumption: Another lifestyle aspect with dental implications.
    • Use of Dental Floss: Understanding daily dental hygiene practices.
    • Frequency of Brushing: An important part of dental health.
  • Consent and Signature:
    • Consent for Treatment: Legalities made simple with a checkbox.
    • Signature and Date: To acquire the consent of the client.

Sign up with WPForms today and access the Dental Health Assessment Form Template to make patient registration a breeze and give your patients the smooth and caring experience they deserve.