DENTAL PATIENT ONBOARDING CHECKLIST TEMPLATE

Created by ChecklistGuro (https://checklistguro.com)


--- PRE-APPOINTMENT COMMUNICATION ---
[ ] Appointment Date
[ ] Appointment Time
[ ] Appointment Type (New Patient Consultation, Routine Cleaning, Restorative Treatment, Emergency Visit)
[ ] Confirmation Message Sent (Details)
[ ] Confirmation Method (Phone Call, Text Message, Email)
[ ] Pre-Appointment Instructions Document

--- PATIENT ARRIVAL & CHECK-IN ---
[ ] Patient Arrival Time
[ ] Patient Name (Confirm)
[ ] Date of Birth (Confirm)
[ ] Insurance Provider (Confirm)
[ ] Patient Temperature (Optional)
[ ] Reason for Visit (Confirm) (New Patient, Recall/Check-up, Restorative, Cosmetic, Emergency)
[ ] Patient Signature (Confirm Arrival)

--- MEDICAL & DENTAL HISTORY REVIEW ---
[ ] Chief Complaint (in patient's own words)
[ ] Past Medical History
[ ] Past Dental History
[ ] Current Medications (Prescription Medication, Over-the-Counter Medication, Supplements)
[ ] Blood Pressure (Systolic)
[ ] Blood Pressure (Diastolic)
[ ] Allergies (if any) (No Known Allergies, Medication, Food, Environmental)
[ ] Family Dental History

--- CONSENT FORMS & DISCLOSURES ---
[ ] HIPAA Notice Acknowledgment (Received and Understood, Received but Need Explanation)
[ ] Financial Policy Acknowledgment (Received and Understood, Need Further Explanation)
[ ] COVID-19 Screening Acknowledgment (Completed Screening Form, Reviewing Form Now)
[ ] Any Questions or Concerns?
[ ] Patient Signature
[ ] Date of Consent

--- FINANCIAL DISCUSSION & INSURANCE VERIFICATION ---
[ ] Estimated Treatment Cost
[ ] Patient's Estimated Copay
[ ] Insurance Responsibility (Estimated)
[ ] Payment Options Discussed (Cash, Check, Credit Card, Payment Plan, Other)
[ ] Financial Forms Reviewed? (Financial Policy, Authorization for Treatment, Payment Agreement)
[ ] Insurance Verification Date
[ ] Insurance Verification Notes
[ ] Insurance Pre-Determination Completed? (Yes, No)

--- EXAM ROOM PREPARATION & PATIENT COMFORT ---
[ ] Room Temperature (Fahrenheit)
[ ] Surface Disinfection Complete? (Yes, No)
[ ] Equipment Functionality Check (Light, Chair, Delivery System, Computer)
[ ] Privacy Screen Position (Correct, Needs Adjustment)
[ ] Proof of Disinfection (Image/Record)
[ ] Ambient Music Selected?
[ ] Patient Materials Available? (Yes, No)

--- INITIAL EXAMINATION & ASSESSMENT ---
[ ] Appointment Start Time (Actual)
[ ] Chief Complaint (Pain, Broken Tooth, Cleaning, Cosmetic Concerns, Other)
[ ] Detailed Description of Chief Complaint
[ ] Overall Oral Health Assessment (Excellent, Good, Fair, Poor)
[ ] Blood Pressure (Systolic)
[ ] Blood Pressure (Diastolic)
[ ] Gingival Index Score (0, 1, 2, 3)
[ ] Notable Findings (e.g., lesions, swelling)

--- TREATMENT PLANNING & RECOMMENDATIONS ---
[ ] Detailed Treatment Plan Description
[ ] Estimated Treatment Cost
[ ] Recommended Treatment Phases (Phase 1: Diagnostic, Phase 2: Restorative, Phase 2: Orthodontic, Phase 2: Prosthetic, Phase 2: Preventative)
[ ] Proposed Start Date
[ ] Number of Appointments Estimated
[ ] Patient Understanding of Treatment Plan (Fully Understands, Partially Understands, Requires Further Explanation)
[ ] Patient Questions/Concerns

--- POST-APPOINTMENT INSTRUCTIONS & FOLLOW-UP ---
[ ] Post-Treatment Care Instructions (Written)
[ ] Medication Instructions (if applicable)
[ ] Follow-Up Appointment Date
[ ] Follow-Up Appointment Time
[ ] Recall Appointment Type (Hygiene Recall, Clinical Recall, Treatment Recall)
[ ] Patient Concerns/Questions (Documented) (Pain/Discomfort, Swelling, Bleeding, Allergies, Other)
[ ] Days until follow-up

--- RECORD UPDATES & DOCUMENTATION ---
[ ] Patient's Medical History Updates
[ ] Notes from Patient Consultation
[ ] Assigned Treatment Plan Number
[ ] Date of Treatment Plan Creation
[ ] Treatment Codes Added to Record (D0140 - Prophylaxis, D1110 - Amalgam Fillings, D4341 - Crown - Porcelain/Ceramic, Other - Specify)
[ ] Scanned Radiographs (if applicable)
[ ] Referring Doctor Name (if applicable)

--- END OF TEMPLATE ---
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