Welcome to Safe Dental Sedation ( Advanced Dental Anesthesia PLLC)

Here we will delineate all the steps for us to work together:

1. We need some information about your office:

  • Practice full legal name

  • Address

  • Practice NPI

Also include your main dentist full name. We will use this information to add your office to our malpractice insurance and to contract together.

2. Information about your oxygen supply.

  • We would like to receive some pictures of your oxygen supply.

See examples below:

3. Supplies your office will need:

  1. An oxygen supply as above

  2. Wheelchair. Amazon as great selection of medical level wheelchairs. Search “Medline Wheelchair” (Click on link)

  3. IV Pole. Search Medline IV pole (Click Link as one example)


Ready to book a case?

We Prefer to be emailed (Info@SafeDentalSedation.com) or texted (703-662-3166) for available dates.

Please contact us for a range of dates even if there is a specific date you have in mind.


Next Steps with Patients

1. Introducing us to the patients:

Please send an email to us and the patient together and use the following body in the email by using “Copy and Paste” & fill in the relevant info (note there are 3 paragraphs):

Hello Mr/ Ms ——-

The purpose of this email is to introduce you to your anesthesiology team for your upcoming dental procedure. The anesthesia team will contact you by text and email with more information and a medical questionnaire to fill out.

Patient last name:
DOB:
Cell number: (A number we can text):
Date of procedure:(Date or TBD)
Time of procedure:
Anticipated Duration:
Email address :

Anesthesiology contact :
HIPAA compliant email:
Info@safedentalsedation.com
Cell Number 1 (703) 662-3166
HIPAA compliant Fax : 1 (502) 385-6689



2. We will evaluate the patient for anesthesia.

  • We will contact the patient and have them fill out our online medical questionnaire form to evaluate them for anesthesia.

  • Elderly patients: Occasionally there will be patients who cannot fill online forms such as the elderly, In these situations please have them fill the paper forms (links below) while they are in your office. Send us the filled forms by fax (1-502-385-6689) or by email (Info@SafeDentalSedation.com).

  • Paper Forms: Please have the patients fill the first 2 forms and give them a copy of the Pre-anesthesia instructions to take home for their reference.

Pre-anesthesia Medical Questionnaire

HIPAA Email Consent

Pre-anesthesia Instructions (& Post-anesthesia Instructions


If a medical clearance or other medical information are needed:

Once we review the patient medical history, many patients will require a medical or cardiac clearance letter as well as other tests such as an EKG or laboratory data.

We will guide you through this.

It will be the responsibly of the dental office’s patient coordinator to contact the patient's physician through this process:

  • Use the clearance form linked below to check mark the items that are needed. We will notify you which items are to be checked.

  • Notify the patient that a medical clearance is needed.

  • Have the patient provide you with the name of their physician and their number. You may want to request this ahead of time if they have medical issues or are elderly.

  • Fax the medical clearance letter (see below) to their physician’s office and confirm that they have received it

  • The doctor’s office will provide us with the information requested.

    Medical Consult / Medical Records Request Form

    PDF Fillable Version