Seal America logo
Developing Forms & Managing Data

Developing Forms & Managing Data

Consent Forms

A consent form is used to request a parent’s permission for a student to participate in a school-based dental sealant program. Consent forms should state that the student’s teeth will be assessed and, if indicated, that dental sealants will be placed on the teeth. Some forms also request the parent’s permission for the student to be re-assessed during the next school year, for missing or partially missing sealants to be replaced, and for sealants to be placed on newly erupted teeth, if needed.

Demographic data are most commonly collected from consent forms. When completing consent forms, parents provide information on the student’s age, race and ethnicity, grade, gender, and dental insurance status. Some consent forms ask for information about the student’s health history and whether the student has a dental home (i.e., ongoing relationship with a dentist). Requests for Medicaid, CHIP, or other insurance policy identification numbers can also be included on the consent form. A wide variety of consent forms have been developed by numerous school- and community-based dental sealant programs. Sample consent forms include the following:

When developing consent forms, collect only the information needed to complete each student’s preventive care plan. Requesting more information than needed will not change a treatment plan. However, it may discourage parents from completing the form.

Other considerations include seeking legal advice to ensure that parents are providing informed consent. Program administrators may also consider having the forms translated into non-English languages, especially in areas where many families do not speak English as a first language. It is desirable to print forms on colored paper so that the forms are easy to identify when it is time to collect them.