To submit the Medical Consultation Request form, you can send it via email to your dentist's office or submit it through traditional mail at the provided address on the form. Alternatively, you may fax the completed form if a fax number is provided. Ensure that all sections are correctly filled out and signed before sending to facilitate a smooth review process.

Important dates for this form include submission deadlines related to specific dental treatments throughout 2024 and 2025. It is recommended to check with your healthcare provider for specific procedures requiring this form. Regular updates may apply, so verify any seasonal policies that could impact your treatment schedule.

The purpose of the Medical Consultation Request form is to ensure clear communication between patients and dental professionals. This form facilitates the documentation of a patient's medical history, aiding in more effective and safe dental treatment planning. By providing necessary medical information, it serves to minimize risks associated with dental procedures.

• 1. Patient Name: Full name of the patient requiring medical consultation.
• 2. Date of Birth: Patient's birth date for identification.
• 3. Phone Number: Contact number for scheduling and follow-up.
• 4. Medical History: Details about any past or current medical conditions.
• 5. Physician's Response: Area for the physician to provide recommendations.

Failure to submit the Medical Consultation Request form may delay dental treatment. It is crucial for ensuring that all medical information is reviewed prior to procedures. If the form is not submitted, the dentist may be unable to proceed with treatments requiring medical clearance.

• Delayed Treatment: Missing out on necessary dental procedures.
• Increased Risk: Potential for complications if medical history is not disclosed.
• Miscommunication: Lack of clarity between patient and healthcare providers.

• 1. Prior to Scheduled Surgery: Ensures all medical considerations are reviewed beforehand.
• 2. For Patients with Chronic Conditions: Documents important medical details that may affect treatment.
• 3. When Referring to Specialists: Provides necessary medical information for coordinating care.