Answer all questions by choosing Yes or No . All responses are kept confidential.
7. DO YOU HAVE OR HAVE YOU EVER HAD:
8. Medications
9. ARE YOU ALLERGIC TO OR HAVE YOU HAD AN ADVERSE REACTION to:
13. FOR WOMEN ONLY
C. If you are using Oral Contraceptives. If is important that you understand that antibiotics (and some other medications) may interfere with the effectiveness of oral, contraceptives. Please consult with your physician for further guidance.
I understand the importance of a truthful and complete Health History to assist may dentist in providing the best care possible. I have had the opportunity to discuss my Health History with my dentist.
Our office is HIPAA compliant and is committed to meeting or exceeding the standards of infection control mandated by OSHA, the CDC, and the ADA.