Patient Management & Forms

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. 

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.

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.

Additional lab costs don't always have to be written off when a patient selects an upgraded service or material. Follow these tips and utilize this form to inform patients of their potential additional financial responsibility.

This is a checklist of required patient and public notifications and disclosures.

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.

Understand how a patient portal can assist your practice with patient communication, record-keeping and overall office efficiency with this resource. Use our checklist to evaluate your practice’s need for a patient portal and valuable features to consider before implementation.  

Format and content, patient access to records and requests to amend, disclosure of information, data breach notification, retention and disposal, transferring records in a sale.

Summary of records release rules with customizable sample form. Patients have the right to access their record and can request paper, film or electronic copies.

Includes information on this patient right to restrict disclosure of patient health information to a dental benefit or health care plan and a sample form to use for a patient who requests such a restriction.

Common patient collection considerations while working with dental benefit plans.

Here you’ll find a compiled list of items to help prepare you for the financial consultation and ensure your team is ready to have a knowledgeable conversation.

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 scripts to help make sure the entire staff is saying the same thing when having financial discussions with patients.

Information regarding the requirements to comply with the No Surprises Act which became effective January 1st, 2022.  The No Surprises Act is an effort to protect individuals and provide transparency related to health care costs. Instructions as well as samples of the required notification and the Good Faith Estimate are included.

This form serves both as a notice that complies with the Dental Board’s requirement and to obtain informed consent for teledentistry.

Here you’ll find some tips to help prepare your team for financial consultations.