To avoid claims of abandonment, dentists who are separating from practice (or the families of deceased or incapacitated dentists) must notify patients in writing.

Certain non-dentists may, upon a dentist's death or incapacity, contract with another licensed dentist or dentists to continue his or her dental practice for a period not exceeding 12 months if certain conditions are met. One of the conditions is to notify the Dental Board.

In the coming months leading up to the addition of a new provider in the practice, it is critically important to announce this significant change to your patients, referring doctors, neighboring businesses, local dental society, and community.

These guidelines offer assistance with the organization of a mutual aid group in the event a dentist suffers a disability or death without the benefit of a pre-written plan.

Did you receive products you did not order, and then were invoiced for them? Have you received an invoice for advertising you did not order? Use this sample letter to notify the company that state and federal law allow you, the recipient, to use or dispos

Notification to School Administrators regarding California Education Code to excuse student from absence due to medical, dental, optometrical and chiropractic treatment. Includes sample of School Excuse Note.

Sample form to request a consultation with a patient’s physician which may be necessary particularly for patients who have chronic conditions.

This form is designed for internal office use only. It should not be shared with the patient and is intended to provide the practice with a way to document personal information about the patient to help refresh staff members’ minds prior to the patient visiting the practice.

There are many options to choose from, and when researching which options your practice will offer, you will likely come across practice owners who have had much success with certain methods and others who have had negative experiences with the same systems.

This document provides sample language for obtaining a patient’s acknowledgment of responsibilities and receipt of information, for obtaining a patient’s affirmation that provided information is correct and the patient agrees to treatment and payment terms.

Information a dental practice should collect when creating a New Patient Form. Annual verification should be done to verify if any changes are needed, such as employer or contact info.

Questions and answers on obtaining consent for minor children with divorced parents or no parents, coordination of insurance plans between parents and step-parents, and who can access records of minor children.

Dentists are obligated to make reasonable arrangements for the emergency care of patients of record. Dental benefit plans require the same of contracted providers. Failure to make such arrangements may result in charges of patient abandonment. Resource in

Informed Refusal of Treatment to be signed by patient, provider and witness to document the discussion between the patient and provider on risks of declining recommended treatment.

Sample informed consent forms to aid in the face-to-face informed consent discussion between the dentist and patient. Available in English, Chinese, Japanese, Korean, Russian, Spanish, Tagalog, Traditional Chinese, and Vietnamese.

Tool to utilize during the patient financial discussion to document financial options presented, patient obligation and financial consent.

Use for existing minor patients whose legal guardians of record have experienced a relationship change (divorce). Send a letter to both parents; responses will help you determine if you need to update the patient information and patient financial agreement.

Sample letter to patient discussing the necessity of radiographs. Courtesy of TDIC.

Form designed for a provider who wishes to collect more in-depth dental health history that is not covered on the Confidential Health History Form, as well as assess the patient’s oral health and/or cosmetic concerns.

Utilize this form when offering patients automatic credit card payments. Be certain to comply with your merchant card processor's security standard for this type of payment.

This form should be completed by each new patient or a new patient’s legal guardian. Additionally, this form should be reviewed at each patient appointment with changes noted and signed for. Used with permissions from TDIC.

Use this sample form to obtain patient consent for use or disclosure of patient information as required by HIPAA and state law.

Dental practices that offer patients commercial credit financing products (credit cards, lines of credit or loans) in the dental office are required to disclose certain information and are prohibited from specific practices. 

Form to be completed by legal guardian to authorize a caretaker (non legal guardian) to accompany a minor to his/her dental appointment. 

This training guides staff through the state and HIPAA requirements for providing access. Instructions on staff presentation are included.