When a road accident damages a patient's teeth, the dentist completes this two-page SAAQ report to support the victim's claim. It records the patient's dental state before the accident, any dentures and whether they broke or were lost, and the teeth or regions injured, from lost teeth and fillings to fractures and soft tissue lacerations. A treatment plan and preoperative X-rays are attached when they exist.
The dentist completes the whole form, including their discipline and permit number, and signs it. The accident victim has no section to complete but must still file their own claim for compensation with the SAAQ, as the report points out.
Download the current version from the source each time; forms change without notice.
Upload the fillable PDF once and Vero Documents fills it from the visit note and the chart, ready for you to review and sign. Download, print, or email the finished form, with the patient’s consent.
A form is listed only after its name and number were confirmed on the issuing agency’s or insurer’s own website, or in the form itself. Each entry links to that source. The list was last checked in October 2026. Forms change without notice, so download the current version from the official page before you fill it in.
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The version revised in April 2024 tells the dentist to send it directly to the SAAQ, through the online document service for external providers or by mail, and to keep the original or a copy. The SAAQ's dentist web page, last updated in 2020, still says to give the signed report to the accident victim, who forwards it.
Preoperative radiographs, if you took any, since the form calls them essential to the file review, and a treatment plan if one is needed, showing the cost and procedure code of each treatment. The report itself records the affected teeth or regions: lost teeth, lost fillings, fractured restorations, teeth or bone, and soft tissue lacerations.
No. The Rapport du ou de la dentiste is published in French only, as a two-page PDF. You can print it and fill it in by hand, or fill it on screen and then print it; either way the dentist signs and dates it and gives their permit number and discipline.