2020 Dental Exam Forms

2020 Dental Exam Forms  – For exams taken in the 2020 calendar year

Restorative Criteria (ADEX)

• Anterior Composite Preparation
• Anterior Composite Restoration
• Posterior Amalgam Preparation
• Posterior Amalgam Restoration
• Posterior Composite Preparation
• Posterior Composite Restoration

Restorative Administrative Forms

• Anterior Progress Form
• Posterior Progress Form
• Chairside Assistant – (Print on Yellow Paper)
• Interpreter Disclosure Statement/ID Forms – (Print on Green Paper)
• Medical History
• Modification Request Form
• Patient Consent Disclosure and Assumption of Responsibility
• Qualified Patient/Tooth/Lesion Treatment Form (For CIF Exams only)

Periodontal Criteria (ADEX)

• Periodontal Clinical Examination

Periodontal Administrative Forms

• Periodontal Progress Form
• ADEX Periodontal Clinical Exam Declaration Form
• Chairside Assistant – (Print on Yellow Paper)
• Interpreter Disclosure Statement/ID Forms – (Print on Green Paper)
• Medical History
• Patient Consent Disclosure and Assumption of Responsibility
• Treatment Selection Worksheet

Endodontic Criteria (ADEX)

• Anterior Endodontic Procedure
• Posterior Endodontic Procedure

Prosthodontics Criteria (ADEX)

• Cast Metal Crown Preparation
• Ceramic Crown Preparation
• Porcelain Fused to Metal Crown Preparation

Endodontic and Prosthodontic Administrative Form

• Prosthodontics & Endodontics Clinical Examinations Progress Form