Dental Emergency Walk-In Form

Streamline Emergency Dental Care with Paperform

When a dental emergency strikes, every minute counts. This Dental Emergency Walk-In Form helps dental practices quickly triage urgent patients, assess their pain levels, and determine the most appropriate same-day treatment—all before the patient reaches the chair.

Built for dental clinics, emergency dental centers, and general practices that offer walk-in services, this template replaces clipboard paperwork with a fast, digital intake process. Patients can complete the form on a tablet in your waiting room or even on their phone before arrival, giving your team critical information to prioritize cases and prepare treatment rooms efficiently.

What makes this template essential for dental practices

This form captures everything you need for emergency triage: chief complaint details, pain assessment using a visual scale, medical history flags, current medications, and insurance information. Conditional logic routes follow-up questions based on the type of emergency—whether it's a knocked-out tooth, severe pain, broken restoration, or infection—ensuring you gather relevant details without overwhelming patients.

The pain management section helps staff quickly identify high-priority cases, while treatment preference questions let patients indicate their comfort level with same-day procedures, sedation options, and cost considerations. This upfront clarity reduces anxiety and helps your front desk set accurate expectations.

Automate your emergency dental workflow

Once a patient submits this form, you can use Stepper to automatically notify the on-call dentist, update your practice management software, check insurance eligibility, and send pre-treatment instructions via SMS. If a patient needs a specialist referral or follow-up appointment, Stepper can trigger those workflows instantly, keeping your emergency response coordinated and professional.

For practices that need signed consent for emergency treatment, you can connect submissions to Papersign to generate and send treatment consent forms for eSignature, creating a complete digital record from intake to authorization.

Designed for dental professionals who value speed and accuracy

Whether you're a solo practitioner handling after-hours emergencies or a multi-location dental group with dedicated urgent care hours, this Paperform template helps you deliver faster, more organized emergency care. It's trusted by dental practices that understand that a smooth intake process reduces patient stress, improves clinical outcomes, and helps your team work more efficiently under pressure.

Start with this template, customize it to match your protocols and branding, and give your emergency patients the professional, compassionate experience they need when they're hurting most.