Dental Screening Form Template

Collect more information about your patient's oral health using this dental screening form template.

Understanding Dental Screening Form Template

A dental screening is an essential part of preventive health care. Dentists/providers can use this template to record the patients' oral health care and history. It helps you record all the patients who visit the clinic and the type of dental ailment they suffer from.

To use this Dental Screening Form Template, just sign up or sign in to Zonka Feedback. You’ll be able to choose this Survey Template when you begin creating your feedback form or survey. Customize it today and start sharing!

List of Dental Screening Form Questions

The following questions are included in the Dental Screening Form Template:

  • Name of patient
  • Enter your DOB
  • Enter date of consultation/screen
  • Choose specific problems • Specify the name of the specialist referred to.

Sign Up on Zonka Feedback for free and implement this Dental Screening Form Template in your account to collect information from patients.

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