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ORAL HEALTH CERTIFICATE

(Dentist use only)
Please select the following that apply, use the space below for further comments, e.g. relevant medical or dental history details.
Required modifications to the teeth such as rest seats have/have not been undertaken.

This certificate of oral heath is provided in good faith, without prejudice, and applies for the purposes of a removable partial denture.

The clinical dental technician remains responsible for the clinical care outcomes in relation to the provision and fitting of the patient's denture. Please sign your name below:

¹     Dentally fit means no diseased or unhealed hard or soft tissues or disorders or abnormalities contraindicating the provision of the partial denture. It also means that the abutment teeth are suitable for a partial denture and that there is no caries, pulp or periapical disease or periodontal conditions requiring treatment.

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²     It is recommended that an expiry of 90 days be used.

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