Patient Management & Forms

Dental Software Transition Checklists

Developed by a long-time information technology veteran and electronic health records expert, these checklists will help you start the transition to a new software.

Access to Patient Records

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

Authorization for a Caretaker to Accompany a Minor Patient

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

Authorization for Agent to Consent to Dental Treatment of a Minor

This form allows for a non-legal guardian to consent to a minor patient’s treatment. It must be signed by a parent or legal guardian.

California State Mandated Reporting

California law designates certain individuals as "mandated reporters” for known or suspected abuse or neglect of a child, elder and dependent adult and incidents of violence. Dentists, and many members of the dental team, are required to acknowledge their responsibility and make reports as well as consider training for their teams.

Caregiver’s Authorization Affidavit

A minor patient who does not have a parent in their life may be under the care of a family member who is not a legal guardian. Use the affidavit when the family member seeks dental treatment for the minor.


Collections Agency FAQ

Answering frequent questions about third party collection agencies. Things to know to stay in compliance with HIPAA and CMIA while working to collect past due patient balances.

Communicating Radiation Safety to Your Patients

Are you confident your patients understand the necessity of diagnostic X-rays? Here are some of the questions you may get from patients and guidance on how to best respond.

Confidential Health History Form (English & Spanish)

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.

Consent Form for Use or Disclosure of Patient Health Information

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

Credit Card Authorization Form

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.

Dental Benefits – What You Need to Know

This resource may be shared with patients to address some of the common questions about dental coverage and where to go when they are experiencing challenges with their dental plan. 

Dental Health History Form

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.

Diagnostic X-rays are Required Letter

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

Divorced Parents Sample Letter (Existing Minor Patients of Record)

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.

FAQ Doctor to Patient Communication Regarding Dental Plan Coverage

This FAQ offers do's and don'ts on how to have patient discussions regarding their dental benefit plans.

Financial Agreement and Consent Form

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

Informed Consent Forms

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.

Informed Refusal Form

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.

Legal Reference Guide for California Dentists - Chapter 5, Patient Considerations

This chapter addresses Patient Considerations including but not limited to: Examination and Diagnosis, Communications and Records.


Creating a welcoming and safe place for LGBTQ+ patients begins with education and training. Here are some reputable resources to help you learn more about LGBTQIA+ oral health and better serve your LGBTQIA+ patients.  

Managing Delinquent Patient Accounts

Helping navigate some of the best practices you can utilize in your office to manage delinquent accounts and collect past due balances.

Managing Emergency Patients When Your Office is Closed

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

Managing Minor Patients: Questions & Answers

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.

Medical Consultation Request

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

New Patient Information Collection

Information a dental practice should collect when creating a New Patient Form during the initial new patient phone call.

New Patient Information Form Bundle

List of forms and information needing completion prior to the patient’s first appointment.