Student Clinic Care Agreement Sample Contracts

Welcome to the UI College of Dentistry!
Student Clinic Care Agreement • October 27th, 2021

We appreciate your interest in receiving treatment in our student clinics. The purpose of today’s screening appointment is to determine if your dental needs and expectations can be met in our student clinics. We will perform a brief examination ($17.00) and take radiographs (fee charged) if needed. If you are accepted as a patient in the student clinics, your dental care will not begin until after your comprehensive exam and treatment planning appointment, which will be scheduled on another day after you have completed this appointment.

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Student Clinic Care Agreement
Student Clinic Care Agreement • July 9th, 2015

We appreciate your interest in receiving treatment in our student clinics. The purpose of today’s screening appointment is to determine if your dental needs and expectations can be met in our student clinics. We will perform a brief examination ($10.00) and take radiographs (fee charged) if needed. If you are accepted as a patient in the student clinics, your dental care will not begin until after your comprehensive exam and treatment planning appointment, which will be scheduled on another day after you have completed this appointment.

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