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Patient Forms

Keeping thorough patient records is an important part of patient care.  We require 5 forms be used in the proper care of surgical patients.  Here you will find the 5 generic copies of the patient forms.  Your office will receive these forms, customized with your information, in your welcome packet.

Pre-Operative Instructions for Dental Surgery

Medical History Update Form

Patient Treatment Record

Disclosure and Consent - Dental and Oral Surgery

Post-Operative Instructions Following Dental Surgery

Please make several copies of each of your 5 forms and keep them together in a file for easy accessibility.  I suggest stapling the forms into a packet.  As you refer a patient to me, pull out a stapled packet of forms, tear off the pre-op and medical history forms, and give them to the patient.  Place the remaining forms in the patient chart so they are easy to find on the day of the appointment.

Please be sure to give each patient a written copy of these Pre-Operative Instructions prior to their surgery.  It is a good idea to review the instructions verbally with the patient both at the time of scheduling and again when you make the reminder call for their upcoming appointment.

On the day of surgery, please be sure to place a copy of the Consent Form, the Post-Operative Instructions, the Patient Treatment Record, along with the treatment estimate, on the outside of the patient chart.  I prefer to review these forms in detail with each patient during their consultation and pre-operative period.

Miscellaneous Forms

Medical Clearance

Implant Consent

VLink Forms

If you are using VLink for scheduling and patient records management, the patient’s medical history form will be automatically sent to them via email.


Contact Dr. Moore

(214) 529-5218