Get Please Complete & Return This Form On The Next Day Of School

Filling out the PLEASE COMPLETE & RETURN THIS FORM ON THE NEXT DAY OF SCHOOL is essential to ensure your child's participation in the dental screening program. This guide provides a clear, step-by-step approach to help you fill out the form accurately and efficiently online.

Follow the steps to complete the form effectively.

1. Click the ‘Get Form’ button to obtain the consent form and open it in your preferred digital editor.
2. Begin by entering your child’s information in the ‘Patient Information’ section. Provide their full name, date of birth, and grade level. Indicate their gender by selecting either ‘M’ for male or ‘F’ for female.
3. Fill in your contact information under the ‘Phone’ section. Next, provide any relevant details about your child’s teacher and school to ensure accurate processing.
4. Complete the ‘Address’ section with your child's home address, including city and ZIP code.
5. In the ‘Insurance Information’ section, indicate whether your child is covered by Medicaid, private dental insurance, or is uninsured by checking the appropriate box. Provide the necessary identification numbers as requested.
6. Fill out the ‘Health History/Information’ section. Check any relevant health problems your child may have experienced. Also, list any known allergies and medications.
7. In the section indicating whether your child is currently experiencing dental pain, provide a clear indication if applicable.
8. A parent or legal guardian must sign the consent to authorize the dental services for your child. Therefore, please ensure to sign, print your name, and include the date of signing. Specify your relationship to the child in the designated area.
9. Review all the information entered to ensure accuracy. Make any necessary adjustments before finalizing the form.
10. Once completed, you may choose to save your changes, download the document, print it out, or share it as required.

Complete the necessary documents online to ensure your child's dental health needs are addressed promptly.