Halifax Community College - Dental Office Observation Form

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:  ____________