ADA Patient Screening Form

An interactive, intuitive, and functional ADA patient screening form template that gives you freedom from paperwork.

By Katherine Ellison on Jun 03, 2024.

Fact Checked by RJ Gumban.

Use Template

What Is a ADA Patient Screening Form

form is used by American Dental Association (ADA) as a questionnaire for dental professionals to assess the suitability of a patient for treatment. This form primarily screens for COVID-19-related symptoms in response to the pandemic. It includes screening for common COVID-19-related symptoms and populations that are more susceptible and vulnerable to COVID-19 infection. The goal of the patient screening form is to identify any potential risks or contraindications that may impact the dental treatment, ensuring the safety of the patient and limiting the possible spreading of viral infections. We have designed this template so that it includes all the necessary information for an ADA patient screening form and is more accessible since you can directly interact with the PDF without printing it. These forms can be easily distributed by dental practitioners to their patients to maximize the quality of care and protection of patients’ health. In this guide, you will find instructions on how to utilize this template in detailed steps, a sample template, and various benefits associated with using this form.

Printable ADA Patient Screening Form

Download these templates for ADA Patient Screening Forms to improve your client intake process and HIPAA compliance.

How To Use This Template For ADA Patient Screening Forms

It is easy and hustle-free to use our ADA patient screening form template. We designed the template so that it is intuitive to use. If you are not sure about how to approach it, here are some simple steps you can follow:

Step One: Download the PDF

Download the PDF onto your devices before doing anything. We have made this ADA patient screening form template into an interactive PDF, so you can fill it out straightaway on your devices. Alternatively, you can also print it out or access it within the Carepatron template library.

Step Two: Distribute to Your Patients

If you are the dental practitioner yourself, you need to send these forms out to your patients and have them fill them out. Make sure you communicate with your patients, so they can receive these forms in a way that is accessible to them. The eldest generation may not be as familiar with electronic devices as you are.

Step Three: Examine the Forms

After you receive the completed form from your patients, double-check the filled form to ensure all the required information has been provided. If there is any problem with missing information or the readability of their handwriting, make sure you confirm all the details with your patients.

Step Four: Documentation

If the forms are free of errors, it is time to document them in your patient profiling system. Whether you are storing them digitally or physically, these are strictly confidential information and should not be shared without patient consent, so make sure they are stored securely.

ADA Patient Screening Form Example (Sample)

If you are not too confident about how to approach this form, we have created an ADA patient screening form sample template to give you an idea of what it will look like after being fully completed. Feel free to download the sample template and have a play around. Once you are comfortable with it, you can find the clean and ready-to-use ADA patient screening form template on this page.

Download this ADA Patient Screening Form Example (Sample) here:

ADA Patient Screening Form Example (Sample)

Who Can Use this Printable ADA Patient Screening Form (PDF)?

The American Dental Association (ADA) originally developed the ADA patient screening form. Therefore, this patient screening form was made to use by dental practitioners. There is no restriction on what type of dental practitioner you are, and you certainly do not have to be a fully trained dentist to use it. Here are some examples of dental practitioners:

  • Dental Hygienist
  • Dental Nurse
  • Dental Technician
  • Dental Therapist
  • Dentist

Nevertheless, if you are working with other types of healthcare professionals who are wanting to screen your patients or clients for COVID-19, ADA patient screening form can still be a decent choice. The nature of content within this form is focused on COVID-19 symptoms and associated risk factors that can make patients vulnerable and susceptible to infection, so feel free to give it a try.

Why Is This Form Useful For Dentists

Identify Risk

Dental care services have direct contact with the oral cavity which constitutes the respiratory system that is the primary pathway of spreading COVID-19. Identifying early and potential risks of COVID-19 before contact with the patient can significantly reduce the odds of spreading COVID-19 during the practice.

Legal Requirements

It is part of the legal requirements in many countries to screen for COVID-19 within the healthcare setting. By using our ADA patient screening form, you can easily satisfy these legal requirements and save yourself from extra annoyance. 

Improve Efficiency

We designed our template to ensure it is intuitive and functional. By using a predesigned and consistent ADA patient screening form template, you can save tons of time from doing paperwork and trying to get everything organized.

Dentist Software Feedback

Why Use Carepatron For ADA Patient Screening Form?

Carepatron is a digital patient managing platform that allows you to create digital templates, online invoicing and billing, manage appointments, and lots of other functions that you can explore. We have a large premade template library that includes various forms, note templates, assessments, etc. By accessing these forms through the Carepatron platform, you can adjust the details based on your personal need, and store them online. The autosave and syncing feature would allow you to access your form, templates, or notes from anywhere in the world without losing information or delay. 

The Carepatron platform is also an incredibly secure platform that is HIPAA compliant. Our database uses AES-256 encryption that matches the internet security level of banks. The facility in which digital information is stored has 24/7 surveillance with professional security measures at the perimeter and entry points of the building.

ADA Patient Screening Software
How to create an ADA patient screening form?
How to create an ADA patient screening form?

Commonly asked questions

How to create an ADA patient screening form?

To create an ADA patient screening form, you either download the PDF template or access it from our Carepatron template library. You can find the specific steps on how to do this on this page and the linked video.

What is required on an ADA patient screening form?

The ADA patient screening form requires the patient to complete every question that is listed there. It is not a complicated form, and all the questions are easily understandable. If your patient has reading difficulties, try reading it out to them. After all the questions are answered, a patient signature is required at the bottom for them to acknowledge that their statement on the screening form is true to the best of their knowledge.

Why is an ADA patient screening done?

The ADA patient screening form must be completed for legal requirements and patient safety. It screens for vital information about COVID-19 to limit spreading and protect a vulnerable population. The ADA patient screening form is not the only option out there though, and the healthcare practitioner has the freedom to use any forms that provide an equivalent function

Join 10,000+ teams using Carepatron to be more productive

One app for all your healthcare work