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TREDYFFRIN / EASTTOWN SCHOOL DISTRICTFamily Dentist ReportGrades 3, 7, and all new students to PennsylvaniaThe Pennsylvania School Health Law requires dental examinations in grades 3, 7, and all new students to Pennsylvania. It is strongly recommended that your family dentist perform the exam as they are the most familiar with your child’s dental needs and will be able to provide follow up treatments, cleanings, etc. This examination form should be completed by your family dentist and returned to your child’s school nurse.NAME:______________________________________ SCHOOL:____________________ GRADE______Date of Dental Exam:____________________________________Please check one:Is the child under treatment Yes_______ No_______Treatment completed Yes________ No_______Signature of Dentist:______________________________________Print Dentist Name: ______________________________________Address__________________________________________________Phone__________________________________________________ ................
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