Ever tried searching for “free printable dental clearance forms” on the internet only to hit a paywall or get stuck with a form you can’t even edit?
We get it.
Dental assistants, office managers, patients and caregivers need an uncomplicated form that works efficiently without unnecessary complexities.
Most forms you find online are either:
- Static PDFs: You can’t type in your information or make any changes.
- Hidden behind subscriptions: What looked free suddenly costs money.
- Not practical: They don’t fit how a real dental office works.
That’s why we made it easy!
We’ve created 5 free dental clearance form templates that you can use right away.
They’re available on Google Docs, which means:
- No sign-up needed.
- No fees.
- Completely customizable: You can easily type in information and make any changes you need.
Say goodbye to the frustration and get the forms you need, instantly!
Usage Note: These templates are free to use for both personal and commercial purposes. However, redistribution, resale, or uploading these templates to other websites or platforms for download or sale is strictly prohibited. Please respect the effort that went into creating these resources by using them responsibly.
What is a Dental Clearance Form?
A dental clearance form is like a green light from your dentist.
The document certifies that your oral health meets medical standards for upcoming procedures you need such as surgery or chemotherapy treatments.
Think of it this way: Your medical procedure requires doctors to verify that your oral health won’t interfere with the treatment. Your dentist inspects your mouth for any infections or severe gum disease.
After a thorough review, they sign the required form which grants you permission to proceed with your treatment.
Template 1: Standard Dental Clearance Form
Here is your free printable dental clearance form you’ve been looking for! It is super simple, looks professional and is a breeze to edit.
We’ve included all the important sections you’ll need, like:
- Patient information
- Recent dental history
- What the dentist found during the check-up
- And, of course, the clearance status
This blank dental clearance form is perfect for any setting—whether it’s a general dental office, a hospital, or a specialist’s practice.
No matter if you’re getting a patient ready for a big surgery or just a regular treatment, this form will get the job done.
Template 2: Medical Clearance Form for Dental Treatment
This dental clearance form is a clean, black-and-white version that’s super easy to print and works everywhere.
It’s perfect for dental offices that like straightforward paperwork that looks great whether it’s on your computer screen or printed out.
This form includes important sections like:
- Details about the patient’s referring physician along with the medical procedure that they require.
- Dentist’s notes from their check-up and X-rays.
- The decision of patient clearance followed by a brief summary of dental care provided.
Think of it as your reliable, printable medical clearance form for dental treatment that’s also an editable dental clearance form so that you can edit it as needed.
Template 3: Dental Clearance Form for Surgery (Pre-Op Form)
Patients preparing for major operations such as orthopedic surgery, cardiac surgery, or organ transplants usually need a specialized dental clearance form.
This template meets the precise requirements for the specified purpose.
It highlights the urgency and significant impact of oral health on systemic conditions, ensuring no hidden dental issues compromise the patient’s overall well-being during such critical times.
This makes it an ideal pre-op dental clearance form, perfect for scenarios like dental clearance for heart surgery or other complex orthopedic procedures.
Great for:
- Hospitals needing reliable pre-surgical assessment forms.
- Medical professionals requiring medical clearance from dental professionals before complex treatments.
- Ensuring comprehensive patient care by integrating dental health into the surgical preparation.
Template 4: Dental Clearance for Bisphosphonate or Chemotherapy Patients
This template serves patients who require special attention to oral health during specific medical treatments.
Patients under bisphosphonate therapy or receiving chemotherapy or other high-risk treatments require this essential form.
The specialized medical clearance dental form enables dental professionals to assess potential complications such as osteonecrosis and infection risks while also identifying healing impairments prior to initiating or continuing necessary medical treatments.
The form helps protect patients by taking early action on dental health issues.
Template 5: Dental Clearance Form for Orthodontic Treatment
Getting ready for braces, clear aligners, or other corrective dental work?
Before receiving orthodontic treatment patients typically require a specific dental clearance form. This template is designed exactly for that!
The form ensures patients don’t have any current oral health issues before beginning orthodontic treatment.
The form contains all necessary sections to record information an orthodontist needs before proceeding with treatment.
- Dental hygiene status
- Bite alignment
- Gum health
- The form addresses any existing dental work patients have undergone which includes fillings or crowns.
The form is appropriate for use with both adult and pediatric patients to facilitate their entry into orthodontic treatment.
