Use the 2021 edition of the ADA Patient Dental and Medical Health History Information Form to collect pertinent health information and history from your patients before treatment. Clear two-sided layout and simple wording make form completion easy. Includes questions related to dental history, medications and other substances, allergies, medical and surgical history, and general medical symptoms. An additional Patient Screening Form is now included to assess patients for possible symptoms of COVID-19 in advance of their office visit. The form includes lines for pre-appointment and in-office responses that can be used to evaluate if a deeper discussion with the dentist is needed before treatment.
NOTE S500 Print forms are not listed here Downloadable