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Preventive Dental Program Patient Registration and Consent Form PLEASE PRINT (All items refer to the child for whom services are requested.) Please fill out this form today and return it to your children
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Preventive dental program aims to promote oral health and prevent dental issues through regular check-ups, cleanings, and fluoride treatments.
Dental facilities and providers are required to file preventive dental program.
To fill out preventive dental program, providers need to document all preventive services provided to patients.
The purpose of preventive dental program is to improve oral health outcomes and reduce the need for costly dental treatments.
Information that must be reported on preventive dental program includes patient demographics, type of preventive services provided, and date of services.
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