River Vale Schools -- Dental Form

River Vale Schools
River Vale, NJ

Dental Form

		Date:_________________
Name _________________________	Grade ______	Teacher _______________

has had all necessary dental work (including prophylaxis) completed and is advised to return in _____ months for re-examination.

Dentist's signature __________________________

PLEASE RETURN THIS FORM TO THE SCHOOL NURSE

NOTE: This dental form may be returned to school at any time during the school year