Get Health Assessment Form

Filling out the Health Assessment Form online is an important step in ensuring your child's oral health needs are recognized and addressed. This guide provides clear, step-by-step instructions to help you complete the form accurately and efficiently.

Follow the steps to fill out the Health Assessment Form online.

1. Click ‘Get Form’ button to access the Health Assessment Form and open it in your browser.
2. Begin with Section 1, which must be completed by the parent or guardian. Enter your child's first name, last name, birth date, and gender. Provide the middle initial and grade as well. Indicate your child's race/ethnicity by selecting one of the options provided, and include the school name and teacher's name.
3. Move on to Section 2, where a licensed dental professional will fill out the oral health data. Input the assessment date along with whether visible caries and/or fillings are present. The dental professional will also indicate any treatment urgency with the appropriate selection.
4. If you are unable to take your child for an oral health assessment, go to Section 3. Here, you can request to be excused from the requirement. Select the reason that applies to your situation, and provide the name of the insurance plan if applicable.
5. Sign and date the form in the designated areas where indicated for both the parent/guardian and dental professional.
6. After completing all sections, review the form for accuracy. You may then save your changes, download, print, or share the completed form as needed.

Complete the Health Assessment Form online to ensure your child's oral health needs are met!