Preventive Services Program (PSP): Back to School Message from Dr. Guy Deyton, DDS, State Dental Director
Please Read This Document First – PSP Planning Guide (updated 10/2021)
- Parental Consent Form for Screening and Fluoride Varnish – English – Spanish
OR Parental Consent Form for Varnish Only – English – Spanish (COVID-19 statement added)
- PSP Order Form
- PSP Event Tracking Form (Please print for use at event.)
- Oral Health Screening Results Form – English and Spanish
- Fluoride Varnish Home Care Instructions – English – English and Spanish
- Cover Sheet and Mailing Instructions
- Submit Mandatory PSP Event Report Online
- PSP Screening Form
New Online PSP Screening Form (New as of July 2020)
- Process is simple, quick and no paper screening forms used.
- The link to the Online PSP Screening Form is above. Click on the link to access the form and simply complete the form for each student/child. Instructions on using the Online PSP Screening Form is above.
- Confirm with the screeners they are comfortable using their personal device to collect PSP Oral Screening Data.
- The day of the PSP Event share the Online Screening Form Instructions above with your screener(s).
- If on the day of the PSP event you are not able to use the Online Screening Form, please make paper copies of the PSP Screening Form located above (#8), and order a return envelope or mailing box.
Returning PSP screening forms
- If you have 1 – 150 screening forms, use the postage paid return envelope (manila) included in your order to return the completed forms.
- If you have 151 + screening forms, use the return mailing box included in your order to return the completed screening forms. Attach the enclosed adhesive postage paid label to the box.
- Your mail carrier with the United States Postal Service will pick up the envelope/box with your regular outgoing mail.
- You will still be required to complete a cover sheet for each batch of screening forms mailed.
- Do not return any blank screening forms or unopened fluoride varnish.
Receiving Ordered Supplies
- The order placed using the online PSP Order Form will arrive within 3-5 business days via UPS.
- Please check the order thoroughly once it arrives to determine if any items are missing or buried among the other supplies.
- If your order has not arrived within the expected 3-5 days, please check with your office staff to ensure that the order was not misplaced within the building before contacting your Oral Health Consultant to investigate the whereabouts of your order.