An FP17DC or FP17DCO form is the treatment plan given to a patient at the start of each course.

View an example of the FP17DC or FP17DCO on our website.

When to complete an FP17DC or FP17DCO

An FP17DC form must be issued to all patients, irrespective of their exemption status, for all Band 2 and Band 3 courses of treatment.

An FP17DC form must also be issued for Band 1 courses of treatment if either:

  • it includes private treatment, such as a private hygienist appointment
  • the patient requests a treatment plan.

An FP17DCO must be completed for all accepted courses of orthodontic treatment.

Where to get an FP17DC or FP17DCO

In England, FP17DC and FP17DCO forms can be ordered from Primary Care Support England.

In Wales, FP17DC and FP17DCO forms can be ordered from Shared Services Partnership.

Practices can also use an equivalent version of the form generated by their practice management software. The equivalent version must be signed by the patient and include the same information.