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Dental Office Observation Form
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here for a printer friendly version)
Please complete this form and return to:
Allied Health Admissions Office
Halifax Community College
P.O. Drawer 809
Weldon, NC 27890
Applicant: _________________________
Social Security Number: _________________
During your office visit, you may want to ask the
following questions:
Responsibilities of the Dental Hygienist
- What are the specific job duties related to dental
hygiene practice?
- What are other job duties related to dental office
management and teamwork?
Patient Scheduling
- How many patients are seen in a day by the dental
hygienist?
- How much time is allowed to see a patient?
- How often are patients seen for recall appointments?
Work Environment
- What is the length of work week (days of operation)?
- What is the length of work day (daily hours)?
- What type of uniforms are required in the office?
- Who are the other members of the office staff and
what are their general responsibilities?
- Are staff meetings regularly scheduled and when?
Dental Hygiene as a Profession
- What are the advantages of this profession?
- What are the disadvantages of this profession?
Date of Observation:________________________
Dentist's Name:
________________________________________________
Address:
________________________________________________
_________________________________________________
This is to verify that the above-named applicant spent
4-6 hours observing in a dental office.
Signature of Dentist:
_______________________________ Date: ________________
Signature of Applicant:
_______________________________ Date: ________________ |
