Downloadable dental form: Letter of Medical Necessity for Waterpik

This section of DentistryIQ gives dental professionals the forms they need to make their practices successful.

Content Dam Diq Online Articles 2016 05 Forms 1

This month's featured dental form is a Medical Necessity for Waterpik form. Each month we will feature a new downloadable form to help boost your practice efficiency.


Having trouble selling Waterpiks to your patients? This month’s form will help you get those Waterpiks flying off your shelves.

How, you ask? It’s easy. Use this form as a visual aid to help sell the product.

This form indicates the patient’s current diagnosis and the reason for necessity: gingivitis. This one word explanation helps provide the understanding that Waterpiks are indeed a medical necessity to help control the onset or recurrence of periodontal disease.

As a bonus this form also helps make it an affordable device. According to IRS guidelines, patients can use their Flex Spending Accounts (FSA), Health Reimbursement Arrangement (HRA), or Health Savings Account (HSA) debit card to make the purchase.

So start printing and get to selling those Waterpiks!

Download the Medical Necessity for Waterpick form here, or click on the image above.

Last month's featured form was the Periodontal Charting Form.

The featured form in June was a Patient Refusal of Recommended Treatment form.

If you would like to share any forms you think will be helpful to your fellow OM’s and DA’s, we ask that you forward them to us for publication. Contact Kyle Summerford at, or Meg Kaiser at

Feel free to download and tailor these forms to suit your practice.

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