Please advise us in the future of any change in your medical history or any medications you may be taking.
List current medications, supplements, and or vitamins.
Ask for an additional sheet if you are taking more than 12 medications
We reserve the right to charge for appointments cancelled or broken without 24 hours advance notice
Please refer to our 24 hour answering service for after hours communications.
Please answer YES or NO the following:
PERSONAL DENTAL HISTORY
SMILE CHARACTERISTICS
BITE AND JAW JOINT
GUM AND BONE