Ask the physician the right questions, on one form they can sign and send back.
Finished example
Medical clearance for dental treatment
Ready after review
One page, rendered by ToothNote.ai for a fictional patient and practice. The physician section stays blank for the physician's office to complete, sign, and fax back to the number in the footer.
ToothNote.ai prepares a one-page medical clearance form from the planned treatment and the patient's reported conditions. The physician answers a fixed set of questions, signs, and returns the form to your practice.
One-page form, not a letterPrefilled from the approved examEmail the PDF or print and faxYour letterhead, your name on the form
One page, rendered by ToothNote.ai for a fictional patient and practice. The physician section stays blank for the physician's office to complete, sign, and fax back to the number in the footer.
Why a form
Physicians return signed forms. They do not write letters back.
The first version of this workflow produced a prose letter. The first real clearance died in draft because the physician's office works from a form they can check, sign, and fax. The form is now the artifact. Every question the physician needs to answer is already on the page.
Fixed physician questions
Antibiotic prophylaxis, anticoagulant interruption, permitted antibiotic, additional precautions, and a signature and date line. The same questions on every form, so the physician's office knows exactly what to return.
Planned treatment as checkboxes
Cleaning, radiographs, extraction, implant surgery, sedation, local anesthetic with epinephrine, and an Other line that carries tooth numbers.
Conditions in two lines
ToothNote.ai drafts the patient's reported conditions and your comments to the physician from the exam and health history. Nothing enters the narrative that is not in the record. You edit both fields in place and the preview re-renders.
Return instructions from your settings
When your practice fax is on file, the footer tells the physician to sign and fax the form back to you. No hardcoded text.
One connected workflow
How a clearance moves
Start from the Home grid or from an approved exam. Staff can prepare the form; the signing clinician approves it.
01
Start the clearance
Choose New Medical Clearance, or add one from an approved exam so the patient, treatment, and conditions are prefilled.
02
Name the physician
Enter the physician and their email, or pick a recent recipient.
03
Confirm the treatment and the two drafted fields
Toggle the treatment boxes, edit the conditions and comments, and watch the form preview update. Dictate changes if that is faster.
04
Approve and deliver
Email the PDF to the physician's office, download it, or copy the text. ToothNote.ai marks the clearance sent only after the email is accepted.
05
Receive the signed form
The physician's office returns it by fax or email. Your team files it in the practice management system, which remains the record.
Clear boundaries
What ToothNote.ai does not do here
ToothNote.ai does not transmit faxes, does not collect an electronic signature from the physician, and does not track whether the form came back. The clearance round trip runs on paper and fax in most physician offices today, and the form is built to survive that trip: large check boxes, high-contrast lines, one page at typical length. Your practice management system stays the official chart.
Plan availability
Start with the work you need.
Medical Clearance is included in Pro and Practice. Any team member with write access can prepare a clearance; the signing clinician approves it. Practices can upload their own clearance form layout in Settings under Format.
What is a medical clearance form for dental treatment?+
A one-page form sent to a patient's physician before treatment that asks whether the planned dental procedure is safe given the patient's medical conditions and medications. The physician answers the questions, signs, and returns it to the dental practice.
Why a form instead of a letter to the physician?+
Because physician offices return forms, not letters. Our first version produced a prose letter and the first real clearance died in draft, because the physician's office works from something they can check, sign, and fax. The form is now the artifact, and every question the physician needs to answer is already on the page.
Does ToothNote.ai fax the clearance form or track whether it comes back?+
No. ToothNote.ai does not transmit faxes, does not collect an electronic signature from the physician, and does not track the return. The clearance round trip runs on paper and fax in most physician offices today, so the form is built to survive that trip with large check boxes, high-contrast lines, and one page at typical length.
Can we use our practice's own clearance form layout?+
Yes. Practices can upload their own clearance form layout in Settings under Format.
Who on the team can prepare a clearance?+
Any team member with write access can prepare one, starting from the Home grid or from an approved exam. The signing clinician approves it. Medical Clearance is included in Pro and Practice.
