Special Needs Dental Assessment
Patient Information
Full Name
Date of Birth
Gender
Contact/Carer Name
Contact Number
Medical History
Primary Diagnosis
Notable Medical Conditions
Current Medications
Allergies
Communication & Behaviour
Preferred Communication Method
Behavioural Considerations
Mobility & Support Needs
Mobility/Physical Aids
Specific Support Required
Oral Health Assessment
General Oral Health Status
Clinical Findings
Treatment Needed
Additional Notes
Other Relevant Information