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Dental Health Form

About this Form

Form number: 525-17

Audience:  Parents/Guardians

Last revised: February 2023

INSTRUCTIONS: School health professionals review student health information, including dental health, when students enroll in school. When health problems are identified, school health professionals assist students and parents/guardians in accessing appropriate health services, including dental care.

Parent/Guardian: Please complete Section I of this form and ask your child’s dentist or dental hygienist to complete and sign Section II of this form. Return the completed form to the health room at your child’s school.

Help in locating a dentist/dental hygienist may be obtained by contacting the Maryland State Dental Association at If you do not have access to dental care, please contact the school nurse in your child’s school.

Adobe PDF Dental Health Form41 KEnglish
Adobe PDF Formulario de Salud Dental44 KSpanish
Adobe PDF Formulaire de Santé Dentaire40 KFrench
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Adobe PDF 치아 건강 양식53 KKorean
Adobe PDF የጥርስ ጤና ቅጽ69 KAmharic

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