There are a number of forms that patients are required to fill out and sign, whether they are first time or repeat patients. The following are some of the forms that patients fill out, and the purpose they serve:

  1. Consent forms

A consent form is your way of saying you’ve weighed any risks and have made your decision having factored them in.

Consent forms are meant to protect the patient. An adult who is fully conscious and in possession of his or her mental state cannot be forced to go through a medical procedure. Even in cases where a patient is unconscious, there’s always a provision for someone who can give consent (known as ‘advance directive’).

Consent forms are not required when undergoing simple tests or treatments. It’s assumed that since during simple procedures patients are in control of the situation, you can choose at any time to stop taking part. There’s an exception to this rule. Screening for diseases such as cancer require consent due to the sensitivity of such diagnosis. Signing a consent is required when you are going through treatment that leaves you vulnerable.

It’s expected that patients will sign documents under informed consent.

Informed consent

  • Requires that the dentist or other practitioners at the clinic, give information, whether by full disclosure or by providing reasonable information, that will facilitate decision making about a treatment or test. Informed consent assumes that a patient is legally able to make decisions.
  • For it to apply, the information must be clearly understood by the patient. As a patient, you should take time to ask questions and get a clear understanding as you share in the liability of informed consent.
  • Informed consent assumes that decisions are not made under pressure.
  1. Patient registration

This section allows the patient to provide personal details such as name, social security number, age, address, contact numbers, marital status and insurance details. When the patient is a minor, the details of a person who can give consent are also required.

  1. Health history

This is important because it gives the dentist information about any current treatments or medications that a patient is using, underlying medical conditions, drug allergies and pregnancy.

  1. Additional information about oral health

Through a structured questionnaire, the dentist will collect information about your oral health and behavioral traits that might impact your oral health. This type of information is helpful for creating the best course of treatment for you.

  1. Financial information, including Payments information, insurance and other details.

There’s also a form that provides detailed information for patients with insurance and states who is covered and who is not. Fines and fees are also stipulated. Payment for minors is usually the responsibility of the adult accompanying them.

  1. Privacy

Patient privacy is important, unless the law requires that information to be shared. There’s also information that might be shared with insurance companies in order for them to provide you coverage. It’s important to read the privacy terms before signing.

  1. Consent form for dental images and videos

This form outlines the expectations regarding handling of images such as x-rays. From time to time, such as in consultations with other professionals, it might become necessary for the dentist to share or use X-rays. This part governs such actions.

Please click on the following link to download our forms.

To save the file on your computer: Right click on the link, then select “Save Target As”, choose a location on your computer then click “Save”

Smiles4Fairfax Patient Registration Form

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