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 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