About this Form
Form number: 525-17
Last revised: February 2017
INSTRUCTIONS: School health professionals review student health information, including dental health, when students enroll in school. When health problems are identified, school health professionals assist students and parents/guardians in accessing appropriate health services, including dental care.
Parent/Guardian: Please complete Section I of this form and ask your child’s dentist or dental hygienist to complete and sign Section II of this form. Return the completed form to the health room at your child’s school.
Help in locating a dentist may be obtained by contacting the Maryland State Dental Association at www.msda.com. If you do not have access to dental care, please contact the school nurse in your child’s school.
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