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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