JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.
Sowams School Dental Screening
YOUR RESPONSE IS REQUIRED
Dr. Theodore Drummond DMD will be conducting our yearly dental screening on
February 14th
. Dental screenings are required by the Rhode Island Rules and Regulations for School Health Programs. COVID-19 protocols will be followed to ensure safety during screenings. If your child receives routine dental care from a private dentist they do not need to participate in the screening. Children who do not have a copy of a recent dental exam or a parent response recorded will be screened.
Please complete the form below.
Thank you!
Sign in to Google
to save your progress.
Learn more
* Indicates required question
Email
*
Your email
PLEASE RESPOND TO THE FOLLOWING SURVEY TO ACCEPT OR DECLINE THE DENTAL SCREENING.
*
YES: My child needs to be seen by the school dentist.
NO: My child sees a private dentist regularly & does not need to be seen by the school dentist.
Student Last Name
*
Your answer
Student First Name
*
Your answer
Teacher/Grade
*
Howard K
Silva K
Thronton K
Felag 1
Arguelles 1
Lovegreen 1
Tutt 2
Promades 2
Rackliffe 2
Fagan 3
Gleason 3
Adamson 3
My child's dentist is:
*
Your answer
My child's next or last dental appointment:
*
MM / YYYY
Your answer
Name of parent/guardian filling out form:
*
Your answer
Submit
Page 1 of 1
Clear form
Never submit passwords through Google Forms.
This form was created inside of Barrington Public Schools.
Report Abuse
Forms
