Although dental personal primary treat the area in and around your mouth , your mouth is part of your entire body. Health problems that you may have or medication thay you may be taking, could have an interrelationship with the dentistry you may receive. Thank you for answering the following questions.
Do you have, or have you had, any of the following?
To the best of my knowledge, the questions on this form have 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 status.
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