SD–DENT–01 · United States · not scoped to any state · patient intake forms
31-page form set · 13 sections · plus fill-in checklist, how-to guide and sources · 59 pages across 4 files
The practice is running on a clipboard of forms it inherited from whoever ran it before, with no version number and no record of what the front desk is supposed to collect.
Tick the box above to continue. The button stays off until you do.
Blank business paperwork: fillable PDF forms a business prints or types into. It contains no medical, health or clinical advice, gives no treatment guidance, and states no opinion about any person's condition or care. The practitioner or business owner supplies all clinical content. Nine forms a dental practice hands a new patient, in the order the front desk uses them: registration, a 35-condition medical history, dental history, benefit plan details and assignment of benefits, financial policy, appointment and no-show policy, the acknowledgement that the practice's Notice of Privacy Practices was received, contact preferences, and a records request to the previous dentist. 597 fill-in blanks across 14 sections. Eight of the nine forms are ordinary business paperwork and cite nothing. The ninth sits on a real published duty at 45 CFR 164.520, which is quoted rather than summarised. The Notice itself is NOT in this pack and cannot be: the rule requires it to describe that practice's own uses and disclosures with at least one example each, so this pack supplies the acknowledgement receipt and says plainly that the Notice is yours to write.
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What's inside
What lands in your inbox
You fill in the document itself and hand it on. The checklist is there so you do not leave a blank in it. Everything else is reference. Every file is a PDF you can type into on screen, or print and write on, so you need nothing else to use it.
The rest of the set
Businesses like yours usually start with these. It is where a trade starts, not a complete legal inventory of everything it could ever be asked for — no list on any website is that. Every line below says where it came from.
Showing what a dental practice is asked to carry. It is the only trade on our list that needs this document.
Dental practiceEight items on the list, one of them a multi-file kit rather than a single document. You are looking at one of them. We sell six of the other seven; one we do not have yet.
OURSNot a rule we can point at — this is what the trade gets asked for.
REGA regulator asks for this.
OURSNot a rule we can point at — this is what the trade gets asked for.
OURSNot a rule we can point at — this is what the trade gets asked for.
OURSNot a rule we can point at — this is what the trade gets asked for.
Named because leaving them out would make the list look complete when it is not. Tell us which one you need and it goes on the build queue with your trade attached.
OURSNot a rule we can point at — this is what the trade gets asked for.
We have these written down against this trade but not well enough sourced to tell you a rule demands them. So we are not telling you that.
REGA regulator asks for this.
45 CFR part 160
Your state can add to this. We have written down one place where this trade’s set differs from one state to the next. What we sell is written to the federal baseline, and a state that runs its own programme can ask for more than the federal rule does.
Print this checklistInside the file
01The forms itself, 14 sections with 597 fill-in fields, as a fill-in PDF you can type into
02The published text of the notice duty at 45 CFR 164.520, quoted paragraph by paragraph, so you can check the notice you already have or brief whoever writes it
03A 14-question page on your own state's record retention, minors' consent, record-copy charges and missed-appointment rules
04A new-patient registration, a 35-condition medical history with medicines and allergies tables, and an 18-item dental history
05Benefit plan pages with an assignment of benefits, a financial policy with every figure blank, and an appointment and no-show policy
06The acknowledgement of receipt page, plus the page the rule's own alternative asks for: what you tried and why it was not obtained, written the same day
07A notice posting and website record, a revision log, an acknowledgement log, and a 14-row front-desk file checklist
Plain-English Monday actions
Official-source registry
These are the real rules this plan is built on. Every citation was read against the published text on the date shown above, and each link goes to the official source, not to a summary.
Exclusions
Before you buy
When the law behind this forms moves, or a clause keeps causing an argument, we rewrite it and the new version lands in your account. You do not pay again. That applies to everyone who buys, member or not, for as long as we sell this document.
The files are yours the moment payment clears, so we do not give money back just because you no longer want them. You agree to that in the box above the button before you pay, not afterwards in small print.
If a file is the wrong one, will not open, is missing pages, or does not match what this page says, that is on us and we correct it at no cost, member or not. A version fitted to your business is either included with membership or $49 on its own. That promise is the reason the no-refund rule is fair.
Want this forms edited to match how your business actually works? A non-member buys one tailored edit for $49, no membership needed, and it comes back within 2 business days. A Simply Current membership is $30/month and every fitted edit is included — it wins on the second edit.
One more time, plainly: this is a blank forms and it is scoped to no state. Every state-specific figure in it is left blank for you to fill from your own, and whether what you write in holds is decided by your state's law, often your city's. Check yours before you rely on it.
