Dental Patient Intake Form

The Dental Patient Intake Form covers everything a dental practice needs to know before treating a new patient. Beyond standard demographics and insurance, this template includes dental-specific sections: oral health history, previous dental procedures and restorations, TMJ/jaw pain screening, dental anxiety assessment using a validated scale, and oral hygiene habits.

The medical history section is tailored for dental relevance, focusing on conditions that affect dental treatment such as bleeding disorders, heart conditions requiring antibiotic prophylaxis, bisphosphonate use, and latex allergies. Current medications are captured with attention to drugs that cause dry mouth, gingival hyperplasia, or affect bleeding.

This template works for general dentistry, orthodontics, periodontics, oral surgery, and pediatric dental practices. The dental anxiety scale helps the clinical team prepare appropriate comfort measures for anxious patients, improving the overall patient experience and reducing cancellations.