New York Dental Health Certificate (School, NYSED)

New York schools must request a dental health certificate whenever a health examination is required, at school entry and in grades PreK or K, 1, 3, 5, 7, 9 and 11 (Education Law 903). On this recommended sample, the dentist or dental hygienist states whether the student is in fit condition of dental health and may add oral health findings if the parent agrees.

Who completes it

The parent completes Section 1 with the child's details and any chewing, talking or pain concerns. A licensed dentist or dental hygienist completes Section 2 and signs it.

Submitting and payment

How to submit it
The parent returns the completed certificate to the school, which files it in the student's cumulative health record within 30 days of receipt.
Who pays
The form sets no fee; schools must tell parents that a list of dental hygienists offering free or reduced-cost care is available on request.

Good to know

  • The exam date must be no more than 12 months before the start of the school year in which the certificate is requested.
  • Not in fit condition means a problem interfering with chewing, speaking or focusing on school, such as pain, swelling or infection from open cavities; it does not bar the student from school.
  • The optional section covers caries experience, untreated caries, sealants, soft tissue pathology and malocclusion, plus treatment needs ranging from none to urgent.
  • The certificate is marked optional; NYSED posts it as a PDF and a fillable Word file, updated April 2026.

Get the official form

Download the current version from the source each time; forms change without notice.

Dental Health Certificate

Fill it with Vero

If your copy of the form is a fillable PDF, upload it 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.

How this list is checked

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 and their requirements change without notice, so check the official page for the current version before you complete one.

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Frequently asked questions

Is a dental certificate mandatory for New York schools?

Schools must request one, but providing it is up to the family. NYSED's May 2026 memo says that if the parent does not provide a certificate, or the child is not in fit dental health, the school takes no further action and the student continues to attend.

Who can sign the New York Dental Health Certificate?

Each certificate must be signed by a duly licensed dentist or dental hygienist and describe the student's dental health condition when the examination was done. The exam must be no more than twelve months before the start of the school year.

Which grades need a New York dental certificate request?

Schools request the certificate at the same time a health examination is required: on school entry and in grades PreK or K, 1, 3, 5, 7, 9 and 11. The notice goes out with the health examination notice to parents.