Medical History Update Form
If you have had any change in your health or medical condition it is important for us to understand how this would effect your dental health. This form is for patients to update their medical history profile with us before your next visit and will us to allow plan your treatment plan accordingly.
As required by law, our office adheres to written policies and procedures to protect the privacy of information about you that we create, receive or maintain. Your answers are for our records only and will be kept confidential subject to applicable laws. Please note that you will be asked some questions about your responses to this questionnaire and there may be additional questions concerning your health. This information is vital to allow us to provide appropriate care for you.
This office does not use this information to discriminate.