Dr. O's Free Dental Consultant Letters & Forms
These documents were either created by me or by other individuals who also want to share with the dental community. They are not copyrighted and are freely available for non-commercial use. I have posted all the letters I have.
Page sections: Letters To Dentists | Letters To Patients | Other Letters
Letters To Dentists
- Periodontist
- Referral 1 - comprehensive evaluation
- Referral 2 - comprehensive evaluation
- Referral 3 - comprehensive evaluation
- Referral 4 - grafting evaluation
- Referral 5 - grafting evaluation
- Referral 6 - crown lengthening
- Referral 7 - implant consultation
- Referral 8 - implant consultation
- Referral 9 - implant consultation, with photos in letter
- Endodontist
- Referral 1 - RCT treatment
- Referral 2 - RCT and internal bleaching
- Referral 3 - after accident
- Pedodontist
- Referral - introductory letter
- Orthodontist
- Oral Surgeon
- Referral 1 - extractions
- Referral 2 - extractions in mixed dentition ortho case
- Prosthodontist
- Referral - comprehensive evaluation
- General Dentist
- Follow-up 1 - after seeing his patient on emergency
- Follow-up 2 - after fixing a loose implant screw
- Letter - to new general dentist where moving patient is transferring
- Summary of records - for patients who have transferred to another office
Letters To Patients
- Introducing a new dentist to a practice
- Dropping a PPO provider status 1
- Uncooperative orthodontic patient - warning letter
- Unused Insurance Benefits - sent towards end of year
- Overdue recall 1
- Overdue recall 2
- No Show or repeated tardiness - informs of office policy
- Dismissal 1 - due to repeated no-shows
- Dismissal 2 - due to repeated no-shows
- Dismissal 3 - due to repeated no-shows, cancellations
- Dismissal 4 - unable to attain satisfactory doctor-patient relationship
- Dismissal 5 - unable to attain satisfactory doctor-patient relationship
- Dismissal 6 - uncooperative orthodontic patient
- (You might also want to refer to Tips on Terminating the Dentist-Patient Relationship)
- Need to complete treatment that has not been started
- Need to complete treatment that has been started
- Need to return for crown seat that has been prepped
- Need to return for post and crown after RCT by Endodontist
- Insurance not in effect - claim denied due to no coverage
- Insurance check mailed to patient - requesting endorsement and forwarding
- Request for EOB - dual insurance, first EOB went to patient only
- Refund check enclosed - explanation for check
- Refund for endodontic treatment
- Reply to billing question 1
- Reply to billing question 2
- Insurance explanation - patient frustrated because insurance benefits were used up
Other Letters
- Physician 1 - before hip replacement surgery
- Physician 2 - request for evaluation for antibiotic prophylactic premedication
- Physician 3 - request for consultation on a few issues
- General clearance of dental needs
- Auto and Medical Insurance 1 - concerning injury to front teeth, and potential future treatment
- Auto and Medical Insurance 2 - concerning injury to front teeth, and potential future treatment
- Attorney - in response to alcohol test failure
- Medical insurance - to support NTI device on medical insurance claim
- Dental insurance company - appeal of denied claim, with additional information
- Dental insurance company - additional information being sent
- Dental insurance company - when they request more documentation
- (You might also want to see some of these Dental Insurance Claims resources.)
- Employer 1 - indicating time needed for dental treatment
- Employer 2 - indicating a need for time off work
- Labor and Industries - claim information and treatment plan
Employment
- Job applicants - Position has been filled
