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Thank you for participating in the Preventive Services Program!

PSP Event Steps:

1. Please Read This Document First – PSP Planning Guide (updated 10/2021)
2. Parental Consent Form for Screening and Fluoride Varnish – English – Spanish
3. PSP Order Form
4. Receiving Orders Supplies
5. PSP Event Tracking Form (Please print for use at event. Information is needed to complete the Mandatory PSP Event Report.)
6. Oral Health Screening Results Form – English and Spanish
7. Fluoride Varnish Home Care Instructions – English – English and Spanish
8. Cover Sheet and Mailing Instructions
9. Returning Paper PSP Screening Forms
10. Submit Mandatory PSP Event Report Online
11. PSP Screening Form (Emergency use only)

Additional Resources

• Material Safety Data Sheet for Nu Shield Fluoride Varnish
• PSP Event Set-up Floor Plan Sample Set-up
• Volunteer Recruiting Letter – Dental Professionals