Medical History |
Although dental personnel primarily treat the area in and around your mouth, your mouth is a part of your
entire body. Health problems that you may have, or medication that you may be taking, could have an important
interrelationship with the dentistry you will receive. Thank you for answering the following questions.
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Do you have, or have you had, any of the following? |
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Payment is due in full at the time of treatment unless prior arrangements have been approved. Thank you for filling out
this form completely. It will enable us to help you more effectively. If you have any questions at any time, please ask us.
We are happy to help. Our office is committed to meeting or exceeding the standards of infection control mandated by OSHA,
the CBC and the ADA.