To complete MCPS Dental Health Form 525-17, fill in your child’s name, student ID, school, grade, and date of birth at the top, take the form to a licensed dentist or dental hygienist for the clinical exam portion, and return the signed original to the health room at your child’s school. The form is a single page issued by Montgomery County Public Schools and is available in seven languages.
Who the Form Is For
MCPS requests the dental health form for students entering the school system for the first time, including Pre-Kindergarten and Kindergarten enrollees, and for students transferring in from a private school or from outside Maryland.1Montgomery County, Maryland. School Health Services – Frequently Asked Questions One point worth knowing: unlike the immunization certificate and physical exam, the dental form is not among the documents Maryland law requires for public school enrollment. School health staff still review it as part of each student’s health record and may follow up if the exam flags a concern.
Where to Get the Form
Download it from the MCPS forms website in English, Spanish, French, Vietnamese, Chinese, Korean, or Amharic.2Montgomery County Public Schools. Dental Health Form If you’d rather have a paper copy handed to you, the main office at your child’s assigned school keeps them on hand.
Filling Out Section I
Section I is the top of the form and belongs to the parent or guardian. You need four pieces of information:
- The student’s legal name as it appears on MCPS enrollment records.
- The MCPS-assigned student ID, which you’ll find on registration documents and report cards.
- The school name and the grade for the upcoming year.
- The student’s full date of birth.
Check the student ID and school name against your enrollment paperwork. If either doesn’t match, the health room may have trouble filing the form. Once Section I is done, bring the form with you to the dental appointment.
What the Dentist Completes in Section II
Section II is filled in by a licensed dentist or dental hygienist. Either professional is authorized to sign.3Montgomery County Public Schools. MCPS Form 525-17 Dental Health Form The exam portion asks the provider to check one of three boxes:
- All necessary dental work has been completed.
- Treatment is in progress.
- No dental work is necessary.
The provider also indicates whether dental fluoride was applied (yes or no), enters the date of the student’s last preventive visit, and may add recommendations such as follow-up treatment or a referral. The dental office fills in its phone number, address, fax number, and the date of signing.
Before you leave the office, confirm that the form is signed, the signature is legible, and the exam date is filled in. An unsigned or incomplete form will be sent back for corrections.
Where to Submit It
The form itself instructs, in bold, that it be returned to the health room at your child’s school.3Montgomery County Public Schools. MCPS Form 525-17 Dental Health Form Hand-delivering the signed paper original is the standard method. MCPS does run a ParentVUE portal that lets parents upload certain health documents during registration, but the portal references physicals and vaccination records rather than the dental form.4Montgomery County Public Schools. Technology Information and Support for Parents If you want to send a scan, call the school first and ask whether the health room will accept it; otherwise, bring the original in.
When the health room receives the form, staff check that every field is filled in, that the dentist or hygienist signed and dated it, and that the exam results are clearly marked. If anything is missing, they’ll contact you to get corrections from the dental office. Once accepted, the record becomes part of your child’s school health file.
If You Need a Low-Cost or Free Dental Exam
If paying for the exam is a problem, there are a few routes.
Children enrolled in Maryland Medicaid qualify for the Maryland Healthy Smiles Dental Program, which covers oral exams, cleanings, fluoride, x-rays, fillings, and other services with no premiums, deductibles, or copays. Any child under 21 with full Medicaid coverage is eligible.5Maryland Department of Health. Maryland Healthy Smiles Dental Program The program maintains a provider directory on its website if you have trouble finding a participating dentist.
Montgomery County also runs dental clinics through the Department of Health and Human Services. They provide exams, cleanings, fluoride, fillings, and extractions on a sliding fee scale for county residents whose family income is at or below 250 percent of the federal poverty level and who lack dental insurance. Children must first enroll in the county’s Care for Kids program before scheduling an appointment.6Montgomery County, Maryland. Dental Health Services The county’s Dental Connections Program also refers eligible residents to local dentists who see patients at reduced fees.