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INSTRUCTIONS: PATIENT APPROVAL FORMS ALABAMA DENTAL HYGIENE LICENSURE EXAM

As part of the Alabama dental hygiene licensing process, exams are conducted in which patients agree to receive free treatment and assume the attendant risks. This article discusses the patient release forms which must be signed as part of this process. This packet can be obtained from the website maintained by the Alabama Board of Dental Examiners.

Patient Approval Forms Alabama Dental Hygiene Licensure Exam Step 1: The first page is a cover page.

Patient Approval Forms Alabama Dental Hygiene Licensure Exam Step 2: The second page is a release form. On the first blank line, the patient will enter their signature.

Patient Approval Forms Alabama Dental Hygiene Licensure Exam Step 3: On the second blank line, the patient will enter their date of birth.

Patient Approval Forms Alabama Dental Hygiene Licensure Exam Step 4: On the third blank line, the patient will enter the candidate identification number.

Patient Approval Forms Alabama Dental Hygiene Licensure Exam Step 5: On the fourth blank line, if the patient is a minor, their parent or guardian will enter their signature.

Patient Approval Forms Alabama Dental Hygiene Licensure Exam Step 6: On the fifth blank line, the patient or their parent or guardian will print their name.

Patient Approval Forms Alabama Dental Hygiene Licensure Exam Step 7: On the sixth blank line, the patient or their parent or guardian will enter their street address.

Patient Approval Forms Alabama Dental Hygiene Licensure Exam Step 8: On the seventh blank line, the patient or their parent or guardian will enter their city.

Patient Approval Forms Alabama Dental Hygiene Licensure Exam Step 9: On the eighth blank line, the patient or their parent or guardian will enter their state.

Patient Approval Forms Alabama Dental Hygiene Licensure Exam Step 10: On the ninth blank line, the patient or their parent or guardian will enter their zip code.

Patient Approval Forms Alabama Dental Hygiene Licensure Exam Step 11: The third page requires the signature and identification information of a witness.

Patient Approval Forms Alabama Dental Hygiene Licensure Exam Step 12: The fourth page is an information document.

Patient Approval Forms Alabama Dental Hygiene Licensure Exam Step 13: The remainder of the form contains a patient health history form, a radiographic statement and a periodontal history/treatment plan.