Although dental personnal primarily treat the are in and around the mouth your mouth is a part of your entire body. Health problems you may have or medications that you may be taking could have an important interrelationship with the dentistry you will receive. Thank you for answering the following questions.
To the best of my knowledge, the questions on this form has been accurately answered. I understand that providing incorrect information can be dangerous to my (or patient's) health. It is my responsibility to inform the dental office of any changes in medical employment or insurance status.