Medical Clearance Form


This is the form needed in order to proceed with any dental treatment from a Medical Physician.
To print the Medical Clearance pdf page. Please click here.

referral

Note to Medical Offices:
If our office is requesting this form please note that it will require a urgent reply from you. No answer to this form may result in the patient not being able to go forward with dental treatment. If you are denying to have dental treatment done because of a medical reason please let us know the reason on this form.