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Children's Forms

The Caries Risk Assessment form is completed partly by the parent and partly by the dentist to determine risk.

The Child Dental Medical History form eliminates questions that are not appropriate for young patients.

The Children's Clinical Examination form is for young patients from three to eighteen years old.

The Children's Recall Examination form has space for recall appointments.

The Infant - Toddler Examination form is for children under the age of two and a half.

The Preventive Recommendations form is a two-part carbonless form which includes a take-home sheet for parents to document recommended diet, hygiene, fluoride and treatment.

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Wisconsin Dental Association, 6737 West Washington Street, Suite 2360, West Allis, WI 53214
(414) 276-3954 • (800) 243-4675