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Dental Health Form

About this Form

Form number: 525-17

Audience:  Parents/Guardians

Last revised: February 2017

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 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 Form34 KEnglish
Adobe PDF Formulario de Salud Dental29 KSpanish
Adobe PDF Formulaire de Santé Dentaire30 KFrench
Adobe PDF Đơn Y Tế Nha Khoa99 KVietnamese
Adobe PDF 牙齒保健表119 KChinese
Adobe PDF 치아 건강 양식45 KKorean
Adobe PDF የጥርስ ጤና ቅጽ57 KAmharic

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