Dental Clearance Form — shared by the community
Priya N. shared this 11-question build with 4 conditional rules already wired up. Test it below, then take a copy.
A ready-to-use healthcare, legal & specialized form for teams with a niche process that generic forms don't cover: 11 questions, 1 page, 4 conditional rules.
- Shared by
- Priya N. · Operations lead
- Questions
- 11
- Replies
- 3
- Copies taken
- 524
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Live preview and test console
This is the real form. Answer it to test the 1 conditional rule — nothing is sent or stored.
1 question is hidden by conditional logic right now — change an answer above to reveal it.
Works for you? Take Priya N.'s copy into your own workspace — questions, rules and settings included.
Who this template is for
Dental Clearance Form is built for teams with a niche process that generic forms don't cover who need to capture reproducible detail on first contact.
- Teams with a niche process that generic forms don't cover working in healthcare, legal & specialized.
- Teams who need to capture reproducible detail on first contact without writing code or paying for a custom build.
- Anyone replacing requests that need three replies before work can start with one structured record per enquiry.
- Respondents are the specific group this workflow serves — the form asks them 11 questions across 1 screen.
- Mobile-heavy audiences, thanks to the one-question-per-screen card layout.
Why this form is useful
It removes the cost of requests that need three replies before work can start and turns each submission into a record your team can act on immediately.
- 8 questions are required, so submissions arrive complete instead of needing a follow-up email.
- It records a signature you can keep as proof of agreement.
- It pins the request to a specific date.
- Conditional logic hides 4 questions until they are relevant — shorter forms convert better than long ones.
- Every response is stored, searchable and exportable, so nothing depends on one person's inbox.
How to use this template
From copy to live form is a few minutes of work, and every step is reversible.
- 1Press “Use this template” — a fresh copy of Dental Clearance Form lands in your workspace, ready to edit.
- 2Rename or delete any question, and change what is required. Nothing here is fixed.
- 3Open Notifications and add the email addresses that should be alerted on each submission; add an auto-reply to the respondent if the form collects an email address.
- 4Publish it, then either share the link directly or paste the embed snippet into your site — the embedded form resizes to fit and loads no marketing or advertising trackers.
- 5Watch responses land in Submissions, where you can filter, label and export them to CSV or PDF.
Logic and conditions blueprint
Exactly how this form behaves as it is answered — 4 conditional rules ship with it.
- Features conditional validation: if “Infections or extractions needed?” is Yes, “Findings detail” becomes mandatory before the form can be sent.
- Features advanced show logic: if “Cleared for procedure?” is Not cleared, the form dynamically exposes “Treatment plan and recheck date”. Otherwise that question never appears.
- Features conditional validation: if “Cleared for procedure?” is Not cleared, “Treatment plan and recheck date” becomes mandatory before the form can be sent.
- Features advanced show logic: if “Cleared for procedure?” is Cleared after treatment, the form dynamically exposes “Treatment plan and recheck date”. Otherwise that question never appears.
- All 4 rules are editable in the Logic tab, and the built-in checker warns about rules that contradict each other.
What this form asks
Clearance
- Patient namerequired
- Date of birthrequired
- Referring physician and procedurerequired
- Reason clearance is needed
- Date of dental examinationrequired
- Findingsrequired
- Infections or extractions needed?required
- Findings detail
- Cleared for procedure?required
- Treatment plan and recheck date
- Dentist name and signaturerequired
Conditional logic in this build
- When “Infections or extractions needed?” is Yes, require “Findings detail”.
- When “Cleared for procedure?” is Not cleared, show “Treatment plan and recheck date”.
- When “Cleared for procedure?” is Not cleared, require “Treatment plan and recheck date”.
- When “Cleared for procedure?” is Cleared after treatment, show “Treatment plan and recheck date”.
Questions about this shared form
Who completes this form?
The examining dentist. The patient's details can be pre-filled by the referrer, but the findings, decision and signature come from the practice.
What does 'cleared after treatment' mean?
The patient will be dentally fit once identified treatment is completed. It requires a treatment plan and a recheck date so the referring team can schedule around it.
Is this a medical or legal document?
It is a clinical record used by a referring team. This template is a starting point — align the wording with your practice policies and local requirements.
Can it be printed?
Yes. Submissions export as PDF with the signature included, so a printable copy can go in the patient's notes.
Is the Dental Clearance Form template free to use?
Yes. You can preview and test Dental Clearance Form on this page without an account, and take a copy into your own HelloForms workspace on the free plan. There is nothing to install and no card required to publish it.
What does the Dental Clearance Form template ask for?
It asks 11 questions across 1 page, 8 of which are required. Every question is listed in full further down this page, and each one can be renamed, reordered, made optional or deleted after you copy the template.
Can I edit the Dental Clearance Form form after copying it?
Yes — the copy is entirely yours. Change wording, add or remove questions, switch between the classic and card layouts, restyle it to match your brand, and set who gets notified on each submission.
How does the conditional logic in this healthcare, legal & specialized form work?
4 conditional rules ship with the template: Features conditional validation: if “Infections or extractions needed?” is Yes, “Findings detail” becomes mandatory before the form can be sent. Features advanced show logic: if “Cleared for procedure?” is Not cleared, the form dynamically exposes “Treatment plan and recheck date”. Otherwise that question never appears. Features conditional validation: if “Cleared for procedure?” is Not cleared, “Treatment plan and recheck date” becomes mandatory before the form can be sent. All rules are editable in the Logic tab.
Where do responses to the Dental Clearance Form form go?
Submissions land in your workspace under Submissions, where you can search, filter, label and export them to CSV or PDF. You can also email a notification to your team on every submission and send the respondent an auto-reply.
Can I embed the Dental Clearance Form form on my own website?
Yes. Publish the form and paste the embed snippet into any page or share the direct link. The embedded form resizes to fit its container and loads no advertising or marketing trackers inside the iframe.
Is the signature on this form legally usable?
The template captures a drawn signature and stores it with the submission, along with the timestamp, so you keep evidence of who agreed and when. Whether that is sufficient depends on your jurisdiction and the agreement itself.
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