Get Unmc College Of Dentistry Patient Information Form

Completing the UNMC College of Dentistry Patient Information Form online is a straightforward process that ensures your information is accurately conveyed for dental referral purposes. This guide will walk you through each section of the form to help you fill it out efficiently and correctly.

Follow the steps to complete the form seamlessly.

1. Click the ‘Get Form’ button to acquire the form and open it in your document editor.
2. Begin with the Referring Clinic Information section. Enter the name of the referring clinic or doctor, followed by their phone number. You may also include an optional email address for additional communication.
3. Proceed to the Patient Information section. Fill in the patient's name and phone number. It is important to provide the correct date of birth to ensure proper identification.
4. In the Department for Referral section, select the appropriate box indicating which department the referral is for. Your options include Children’s Dental Day, Endodontics, Oral Pathology, Predoctoral/General Dentistry, Periodontics/Implants, Orthodontics, or Oral Surgery.
5. Next, provide the reason for the referral in the designated area. If there is additional information that could be relevant, feel free to include that in the Optional Additional Information section.
6. If there are any accompanying radiographs, describe them briefly (e.g., BWX, PA, FMX, Pano, Ceph, CBCT). Indicate the date taken to maintain accurate records.
7. After completing the form, save it to a location on your device where you can easily access it, such as your desktop. It is recommended to keep the file name as ‘Patient Information Form’.
8. Finally, upload the completed form and any radiographs to the specified location at UNMC, ensuring all documents are submitted together for processing.

Complete the UNMC College of Dentistry Patient Information Form online today and ensure your referral is processed smoothly.