Form library · DEN-004
Dental child patient
Example only. Not legal or clinical advice. Review and adapt before use. Not endorsed by any government agency. This example has not had a separate legal review.
Rules differ by state; check yours.
Australian dental practices registering a child, with a parent or guardian section.
The child's details, then a parent or guardian section, so the person who signs is the right person. Rules about who can consent for a young person differ by state and by situation. The practice sets its own rule and has it checked.
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Dental child patient
Example only. Not legal or clinical advice. Review and adapt before use. Not endorsed by any government agency. This example has not had a separate legal review.
Fields
Child
Name and date of birth.
Parent or guardian
Name, relationship, mobile and email.
Consent
A tick from the parent or guardian for the child's dental care.
Health information
A tick. The practice collects the health information on the form for care.
Collection notice
A line the practice writes before anyone uses the form.
Signature
Signed by the parent or guardian on the phone.
Questions
Who should sign?
The practice decides, against its own rules and the law in its state. This blank asks for a parent or guardian.
Where does the child's medical history go?
On the dental medical history form (DEN-002). This form registers the child and the person signing.