Medical History Form

/Medical History Form
Medical History Form 2020-08-20T10:51:39+00:00

Medical History Form

MEDICAL ALERT:

IN CASE OF EMERGENCY, WE SHOULD NOTIFY:

The following information is required to enable us to provide you with the best possible dental care. All information is strictly private, and is protected by doctor-patient confidentiality. The dentist will review the questions and explain any that you do not understand. Please fill in the entire form.