Gather details about your patient’s current and prior dental history using our free Dental Health History Form. Our thorough template has you covered! You can rest assured knowing that you are accurately collecting as much information as possible regarding your patient’s dental conditions when using our template. All aspects of the template can be easily customized to match your needs.

We also included a simple internal section for your staff to indicate once they’ve added a patient’s medical history to their file. Using workflow statuses and the Entries page, staff members can easily monitor each entry’s progress and status.

All data collected can be made HIPAA compliant with our Enterprise plan after signing our Business Associates Agreement (BAA). Additionally, our data encryption capabilities can help ensure your data is secure both at rest and in transit.

This template includes Person fields and Lookup fields that automatically pull in data from the Healthcare Employee Lookup form, streamlining the process for your internal team. Additionally, the template features Shared With Me views, enabling the dentist to easily access any patient entries that have been specifically shared with them in Cognito Forms.

Connected Forms:

This template includes one connected form to help you manage your data more efficiently:

• Healthcare Employee Lookup: The form serves as the source of employee information within your healthcare practice, containing data for dentists, admin staff, and any other employee roles you have. It’s linked to a Person field in the internal section of the Dental Health History template, which automatically populates with the name of the staff member who is logged in and making updates. Additionally, a combination of a Person field and a Lookup field connected to this form enables the staff member to select the patient’s dentist from a list of employees at the practice and automatically displays the dentist’s practice area once selected.

Go ahead and customize this template by adding, removing, and editing fields as you see fit. You can modify the existing questions or add your own in as necessary. Additionally, you can style this form as you please or keep your org’s branding consistent with other forms using our Theme feature.