Dental Care Agreement (DCA)

This form is used by Treatment Coordinators at patient treatment conferences to briefly and simply explain the treatment plan and financial arrangements. This DCA is a sample that has been completed with a fictitious treatment plan.

Sample DCA (Adobe PDF format)
Sample DCA (Microsoft Word 2010 format)

English DCA (Adobe PDF format)
English DCA (Microsoft Word 2010 format)

Spanish DCA (Adobe PDF format)
Download Spanish DCA (Microsoft Word 2010 format)

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