Oral Health Screening Form

Posted on: April 5, 2010

Bright Smiles from Birth is an ICAAP educational program that provides guidelines and support to Pediatricians and Family Physicians, Dentists, and families to make oral health a component of well child visits.

The Oral Health Screening Form is a tool to assist providers during oral health screenings.  The form is  a checklist for pre-existing factors, an oral health questionnaire, procedure questionnaire, and a signature field for provider verification.

Oral Health Screening  Form (pdf).


For more information about oral health screening, or Bright Smiles from Birth please contact:

Jennie Pinkwater
Project Director
1400 W. Hubbard
Chicago, IL 60642
Phone: 312/733-1026, ext 213
Fax: 312/733-1791