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Skip Navigation LinksPennsylvania Department of Health > My Health > School Health > Dental Forms
Dental Health Program Forms
 
 
Schools will need to print copies of the Private Dentist Report and School Dental Health Record.
It is recommended that schools provide the dental exam forms on their respective websites for parents or provider offices to print, as needed.
 
Private Dentist Report of Dental Examination of a Pupil of School Age (2011)  This form may be used by both the mandated and dental hygiene programs for students examined by their private providers.
 
School Dental Form.pdfThis form may be used by both the mandated and dental hygiene programs as the dental portion of a student's comprehensive health record. This form may be used by both the mandated and dental hygiene programs as the dental portion of a student's comprehensive health record.
 
Schools may accept exams on the private dentist's own form as long as it comparable to the DOH approved form.
 
 
 
Updated: August 2017