Sample Forms

Customize These Forms for Your Dental Practice

These sample forms were created to assist dentists and their staff in risk management efforts and can be customized to your office. Please note that the information contained in these documents does not establish a standard of care, nor does it constitute legal advice. The information is for general informational purposes only and is written from a risk management perspective to aid in reducing professional liability exposure. Please review these documents for applicability to your specific practice. You are encouraged to consult with your personal attorney for legal advice, as specific legal requirements may vary from state to state.

For additional resources and sample forms, please visit the ProAssurance Risk Management website here.

Patient Termination Letter 

Consent Form for Final Completion/Cementation and Affixation of Prosthesis

Patient Financial Responsibility Policy Form