×
Request a Demo

Book a Demo with Zonka Feedback

Dental Screening Form Template

A dental screening form template is required by dentists and hygienists to gather oral health care and history. With this template, dentists can easily evaluate and assess the risk of developing any oral problems. Just customize this template according to your needs and get started with the form today. 

How does this Dental Screening Form Template Help?

A dental screening is an essential part of preventive health care. Dentists/providers can use this template to record the patients' oral health care and history. It helps you record all the patients who visit the clinic and their type of dental ailment.

Get started right away with a free trial. 

How to use the Dental Screening Template?  

With Zonka Feedback you can reach your customers whenever you want and wherever they are. You can easily run web, email, SMS, mobile and offline surveys. You can also integrate with your existing tools which allows you to sync data, automatic email triggers, deep integrations, and more. 

You will get in-depth real-time reports with graphs and analysis. Click through, filter, and save reports. Set real-time email alerts, slack notifications to loop in your team. 

To use this Dental Screening Form Template, just sign up or sign in to Zonka Feedback. You’ll be able to choose this Survey Template when you begin creating your feedback form or survey. Customize it today and start sharing!

List of Dental Screening Form Questions

The following questions are included in the Dental Screening Form Template:

  • Name of patient
  • Enter your DOB
  • Enter date of consultation/screen
  • Choose specific problems • Specify the name of the specialist referred to.

Sign Up on Zonka Feedback for free and implement this Dental Screening Form Template in your account to collect information from patients.

 

FAQs about Dental Screening Form Questions

1. What is a dental screening template?

Regular dental exams are a critical part of preventive health care. By using this Dental Screening Form, you can learn about any dental issues and their risks. So, you can start using this template and gather information about your patients. 

2. Where can I use this Dental Screening Form?

You can use a QR code at your touchpoint. Another method is to send an email or SMS survey to the customer once the service is completed. If you don't have access to the internet, you can conduct offline surveys using kiosks, mobile devices, or tablets. 

Create and send this Dental Screening Form Template

Get Started