Medical History Form
The medical forms for Children are for those ages 0-17 years old. These forms are to be completed by the child’s parent or guardian and include consent for treatment. If you are under Medicaid insurance, please have a referral from your general dentist, with all needed treatment of cavities completed prior to our initial consult
Our medical forms for Adults should be completed by anyone 18 years of age or older. If you have not had a dental appointment with your regular dentist in the last year, we request that you complete a general dental exam and cleaning prior to your initial
If you are unable to read or speak English, we do have Spanish-speaking interpreters available at the office to assist you with the forms.