Santa Monica Dentist Richard Haber DDS



DENTAL MANTERIALS FACT SHEET

The Dental Board mailed the DMFS to all licensed dentists in mid-November. A copy is available at the CDA web site, , along with a sample Patient Acknowledgement Form. Beginning January 1, 2002 each dentist must provide a copy of the DMFS to any patient (new or of record) prior to commencing any dental restorative work. The dentist must obtain a signed acknowledgement that the patient has received the fact sheet, and a copy of the signed acknowledgement must be placed in the patient’s record.

I HAVE RECEIVED A COPY OF THE DMFS

Patient Signature ________________________________

Dated: ________________

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