Preventive Services Program Forms

group of people

Thank you for participating in the Preventive Services Program!

GO GREEN BY GOING ELECTRONIC! HELPS SAVE PAPER AND SHIPPING COSTS

Prior to PSP Event (4 weeks)

Contact your Oral Health Consultant if you need the Consent & Results Form translated to another language.

Day of PSP Event

After PSP Event (1-2 days)

Plan for 2nd Varnish a Minimum of 3 Months from 1st Varnish

Additional Resources

Fluoride Varnish Information