Get Head Start Dental Form

Filling out the Head Start Dental Form online is a crucial step in ensuring that your child's dental needs are addressed effectively. This guide will walk you through each section of the form, providing clear instructions to help you complete it with confidence.

Follow the steps to fill out the Head Start Dental Form seamlessly.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Begin by entering the child's name and date of birth in the designated fields. Ensure that the name matches the child's identification documents.
3. Next, provide the parent or guardian's name, along with their contact information, including the phone number, address, city, state, and zip code.
4. Indicate whether the practice is the child's dental home by selecting 'Yes' or 'No.' This helps establish the primary care provider for your child.
5. Answer the questions regarding the child's dental health, including whether there are teeth with untreated decay and whether there are teeth that have been previously treated. Choose 'Yes' or 'No' for each question.
6. Assess the treatment needs by indicating if they are urgent, not urgent, or if there are no treatment needs.
7. For the diagnostic and preventive services section, specify whether examination, X-rays, risk assessment, cleaning, fluoride varnish, and dental sealants are needed by selecting 'Yes' or 'No' for each.
8. In the counseling/anticipatory guidance and referral to specialty care sections, confirm if these services are required by selecting 'Yes' or 'No.'
9. Indicate any restorative or emergency care required. For fillings, crowns, extractions, and emergency care, choose 'Yes' or 'No' as applicable.
10. Complete the section regarding treatment completion, indicating if all treatment is completed and whether more appointments are needed. If more appointments are needed, specify the approximate number required.
11. Record the next recall date and the next appointment date and time for the child to return for care.
12. Provide the provider's name, phone number, practice name, address, and signature. Ensure to include the date of service.
13. Finally, review the completed form for accuracy, and then choose to save changes, download, print, or share the form as needed.

Complete your Head Start Dental Form online today to ensure your child's dental health needs are met.