School Entry Dental Examination Requirements
This file provides information about the dental examination requirements for students entering Pre-K and Kindergarten. It includes guidelines on when the examination should be completed and how to provide proof. It helps ensure children have good oral health for school success.
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How do I fill this out?
To complete this form, make sure your child's dental examination is up to date. Obtain proof of the examination from the Dentist, including the date and the Dentist's signature. Submit the proof to your child's school within the grace period.

How to fill out the School Entry Dental Examination Requirements?
1
Ensure the dental examination is completed within one year of pre-enrollment or at the time of enrollment.
2
Obtain proof of the examination from the Dentist, including the date and the Dentist's signature.
3
Use the school's form or the Dentist's form to document the examination.
4
If your child is enrolled in Medicaid or CHIP, the exam will be paid for by them.
5
Submit the proof of the dental examination to your child's school within the grace period.
Who needs the School Entry Dental Examination Requirements?
1
Parents of children entering Pre-K need this form to provide proof of dental examination.
2
Parents of children entering Kindergarten, if they didn't provide proof in Pre-K.
3
School nurses need this form to verify students' dental examinations.
4
Dentists need to complete and sign the form to provide proof of examination.
5
Insurance providers may need the form to verify claims for dental examinations.
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What are the instructions for submitting this form?
To submit this form, ensure all required fields are completed and obtain proof of the dental examination. You can submit the form via email to the school's designated contact, by fax to the school’s office, or through an online submission form provided by the school. Alternatively, you may also submit the form physically to the school's main office. Make sure to keep a copy for your records. My advice is to submit the form as soon as possible to avoid any delays in your child's enrollment.
What are the important dates for this form in 2024 and 2025?
Important dates for this form include the date of pre-enrollment and the 45-day grace period from the first day of class. Make sure to provide proof of a dental examination within these timeframes for the years 2024 and 2025.

What is the purpose of this form?
The purpose of this form is to ensure that children entering Pre-K and Kindergarten have had a recent dental examination. Good oral health is crucial for a child's overall well-being and academic success. By providing proof of a dental examination, parents and guardians help schools ensure that their students are ready for the school year with healthy teeth.

Tell me about this form and its components and fields line-by-line.

- 1. Date of Examination: The date when the dental examination was conducted.
- 2. Dentist's Signature: The signature of the Dentist who performed the examination.
- 3. Child's Information: Details about the child, such as name, date of birth, and school.
- 4. Parent/Guardian Information: Contact information of the parent or guardian.
What happens if I fail to submit this form?
Failure to submit this form may result in your child's delayed or denied enrollment in school. Proof of a dental examination is a requirement for school entry.
- Enrollment Delay: Your child's enrollment may be delayed if the form is not submitted on time.
- Denied Enrollment: Your child may be denied entry into school without the required proof of a dental examination.
How do I know when to use this form?

- 1. Pre-K Enrollment: Provide proof of a dental examination for children entering Pre-K.
- 2. Kindergarten Enrollment: Provide proof of a dental examination for children entering Kindergarten if not previously submitted in Pre-K.
Frequently Asked Questions
What is the purpose of this form?
The purpose of this form is to provide proof of a dental examination for children entering Pre-K and Kindergarten.
Who needs to fill out this form?
Parents or guardians of children entering Pre-K and Kindergarten need to fill out this form.
What information is required on this form?
The form requires proof of a dental examination, which includes the date of the exam and the Dentist's signature.
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Yes, you can add a digital signature to the PDF using PrintFriendly's editor.
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What should I do if I don't have dental insurance?
You can visit WVinRoads to see if you qualify for Medicaid or CHIP.
What is the grace period for submitting the form?
The grace period for submitting the proof of dental examination is 45 days from the first day of class.
Can the school's form be used for documentation?
Yes, the school's form or the Dentist's form can be used to document the dental examination.
What happens if my child needs additional dental work?
Indicate the need for additional dental work on the form so the school can assist with follow-up care coordination.
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