To our patients: Although oral surgeons primarily treat the area in and around you mouth, your mouth is a part of your entire body. Health problems that you may have or medications that you may be taking could have an important interrelationship with the care that you will be receiving. Thank you for answering the following questions. Your answers are for our records only and will be considered confidential.
HAVE YOU HAD OR DO YOU CURRENTLY HAVE
Are you now taking or have you taken
Please list any medications, including over the counter, you are currently taking and/ or attach a list:
Are you allergic to or had a reaction to
Is there a FAMILY HISTORY of
In case of emergency, contact
Women Note: Antibiotics (such as penicillin) may alter the effectiveness of birth control pills. Consult your physician/ gynecologist for assistance regarding additional methods of birth control.