Sample Dental Office Letters
These documents have come from numerous helpful individuals who wanted to share with the dental community, are not copyrighted and were freely available, or were created by me.Please contact me if you have any material you would like to contribute, or if you know of any copyright issues with any of the material.
Letters To Dentists
- Periodontist
- Referral 1 — comprehensive evaluation
- Referral 2 — comprehensive evaluation
- Referral 3 — comprehensive evaluation
- Referral 4 — grafting evaluation
- Referral 5 — periodontist for grafting evaluation
- Referral 6 — periodontist for crown lengthening
- Referral 7 — periodontist for implant consultation
- Referral 8 — periodontist for implant consultation
- Referral 9 — periodontist for implant consultation, with photos in letter
- Endodontist
- Referral 1 — for RCT treatment
- Referral 2 — for RCT and internal bleaching
- Referral 3 — after accident
- Pedodontist
- Referral — introductory letter
- Orthodontist
- Oral Surgeon
- Referral 1 — for extractions
- Referral 2 — for extractions in mixed dentition ortho case
- Prosthodontist
- Referral — for comprehensive evaluation
- General Dentist
- Follow-up 1 — after seeing his patient on emergency
- Follow-up 2 — after fixing a loose implant screw
- Letter — to new general dentist where patient is transferring
- Summary of records — for patients who have transferred to another office
Letters To Patients
- Dropping a PPO provider status 1
- Dropping a WDS/Delta PPO provider status 2
- (You might also want to use the great resources at www.DropThePPO.com)
- No Show or repeated tardiness — informs of office policy
- Uncooperative orthodontic patient - warning letter
- Dismissal 1 — due to repeated no-shows
- Dismissal 2 — due to repeated no-shows
- Dismissal 3 — due to repeated no-shows, cancellations
- Dismissal 4 — unable to attain satisfactory doctor-patient relationship
- Dismissal 5 — unable to attain satisfactory doctor-patient relationship
- Dismissal 6 — uncooperative orthodontic patient
- Need to complete treatment that has been started
- Need to return for crown seat that has been prepped
- Insurance explanation — patient frustrated because insurance benefits were used up
- Authorization to Release Records and X-rays — when patient requests our records be sent out
- Authorization to Release Records and X-rays — for patients requesting records from another office
- Insurance not in effect — claim denied due to no coverage
- Insurance check mailed to patient — requesting endorsement and forwarding
- Request for EOB — dual insurance, first EOB went to patient only
- Refund check enclosed — explanation for check
- Reply to billing questions
Other Letters
- Physician 1 — before hip replacement surgery
- Physician 2 — request for evaluation for antibiotic prophylactic premedication
- Physician 3 — request for consultation on a few issues
- Auto and Medical Insurance 1 — concerning injury to front teeth, and potential future treatment
- Auto and Medical Insurance 2 — concerning injury to front teeth, and potential future treatment
- Attorney — in response to alcohol test failure
- Medical insurance — to support NTI device on medical insurance claim
- Dental consultant — requesting another review of denied claim, with additional information
- Dental insurance — supplemental narrative information
- Employer 1 — indicating time needed for dental treatment
- Employer 2 — indicating a need for time off work
- Labor and Industries — claim information and treatment plan
- Dental Insurance Company 1 — when they request a refund after an account is settled
- Dental Insurance Company 2 -- resignation of dentist/provider agreement
Employment
- Job applicants — Position has been filled
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