In order to provide safe dental care for our patients, we are asking you to print and fill out the following questionnaire. Please answer the questions as accurately as you can. If you have any questions or doubts, check the not sure/maybe choice.

Bring the Health History Form to your appointment with the dentist. The dentist will review your responses with you. You can be assured that the information that you provide will be kept in the strictest confidence.

  Click here to download the Health History Form (65k)

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