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Dental Medical Clearance Form

Learn how a Dental Medical Clearance Form works. Download a free PDF template and sample for your practice.

Ericka Pingol avatar

By Ericka Pingol on Aug 2, 2025.

Fact Checked by Nate Lacson.

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Dental Medical Clearance Form Template

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Commonly asked questions

Medical clearance is generally advised before dental procedures, especially for patients with underlying health conditions like heart disease, diabetes, or compromised immune systems. It ensures that the procedure can be safely performed without exacerbating any existing medical issues.

Patients should seek medical clearance to identify any potential risks or complications that could arise during the dental procedure due to their medical history. This helps in tailoring the procedure to minimize risks and ensure patient safety.

A Dental Medical Clearance Form should include the patient’s medical history, current medications, any allergies, and specific recommendations or restrictions from the physician. It also typically includes the physician’s contact information and a signature confirming the patient is cleared for the dental procedure.

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