Pediatric Dental New Patient Form

Streamline Pediatric Dental Intake with Paperform

Getting accurate health information from parents while keeping young patients comfortable is one of the biggest challenges in pediatric dentistry. This Pediatric Dental New Patient Form helps dental practices collect everything they need before the first appointment—from medical history and insurance details to tooth eruption tracking and treatment consent—all in one friendly, professional digital form.

Built for pediatric dental workflows

This template is designed specifically for children's dentists, orthodontists, and family dental practices that treat young patients. It gathers essential information including the child's dental and medical history, emergency contacts, insurance coverage, and parent/guardian health questionnaire. The form also includes a tooth eruption chart section to track development and a dedicated fluoride treatment consent area to ensure compliance and informed care.

Instead of juggling paper clipboards, illegible handwriting, and missing pages, your front desk team can send this form to parents before the appointment via email or embed it directly on your website. Submissions automatically flow into your practice management software through Paperform's integrations with tools like Airtable, Google Sheets, or via webhook to your dental EHR system.

Why Paperform for pediatric dental practices

Paperform's document-style editor makes it easy to create forms that feel professional and reassuring—important when working with anxious parents and young children. You can add your practice logo, choose calming colors, include images or videos explaining procedures, and use conditional logic to show or hide questions based on previous answers (for example, only asking about previous dental trauma if a parent indicates their child has had an injury).

With Papersign (papersign.com), you can turn form submissions into legally binding consent documents that parents can sign electronically, keeping everything organized and audit-ready. And if you want to automate what happens after a family submits—like sending a welcome email, adding the patient to your scheduling system, or alerting your dental hygienist to review special needs—Stepper (stepper.io) can handle those workflows without any coding.

Paperform is SOC 2 Type II compliant and built with security in mind, so you can trust that sensitive patient information is protected. Whether you're a solo pediatric dentist or part of a multi-location practice, this template helps you deliver a smoother, more modern intake experience that parents appreciate and your team will love.