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SCHOOL HEALTH SERVICES 40320 Markdown RoadWaldoboro, Maine04572(207) 8328109Fax(207) 8328256FLUORIDE VARNISH Programmer Parents:Our Dental Health Education Grant has been written and once again approved.
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How to fill out fluoride varnish permission form
How to fill out fluoride varnish permission form
01
To fill out a fluoride varnish permission form, follow these steps:
02
Obtain the fluoride varnish permission form from the dentist's office or clinic.
03
Read the instructions and information on the form carefully.
04
Provide your personal information such as your name, address, contact number, and date of birth.
05
Fill out the medical history section by indicating any allergies, current medications, and previous oral treatments.
06
Review the risks and benefits section and indicate your consent or refusal for the fluoride varnish treatment.
07
If you have any questions or concerns, consult with your dentist or dental professional before signing the form.
08
Once you have completed the form, sign and date it.
09
Return the filled and signed form to the dentist's office or clinic.
10
Remember to ask for a copy of the form for your records.
Who needs fluoride varnish permission form?
01
The fluoride varnish permission form is typically required for patients who are scheduled to receive fluoride varnish treatment.
02
This form ensures that the patient or their legal guardian understands the potential risks and benefits of the treatment and gives informed consent for its administration.
03
It is common for children and adolescents to require a fluoride varnish permission form, as they often receive this preventive treatment to protect their teeth against decay.
04
However, adults may also be asked to fill out this form if they are undergoing fluoride varnish treatment for specific oral health reasons.
05
It is best to consult with your dentist or dental professional to determine if you need to fill out a fluoride varnish permission form.
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What is fluoride varnish permission form?
Fluoride varnish permission form is a document provided to parents or guardians to authorize the application of fluoride varnish treatment on their child's teeth.
Who is required to file fluoride varnish permission form?
Parents or guardians of children receiving fluoride varnish treatment are required to fill out the form.
How to fill out fluoride varnish permission form?
Parents or guardians must provide their contact information, child's name, date of birth, medical history, and sign to authorize the treatment.
What is the purpose of fluoride varnish permission form?
The purpose of the form is to obtain consent from parents or guardians for the application of fluoride varnish treatment on their child's teeth.
What information must be reported on fluoride varnish permission form?
The form must include contact information, child's name, date of birth, medical history, and consent signature.
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