For new patients
Patient Medical History Form
Please complete this confidential form before your visit. It helps us plan your sedation and treatment safely, and only takes a few minutes.
What you’ll need
A few things to have ready
Having these on hand makes the form faster to complete.
Current medications and dosages, including vitamins and supplements
Known allergies, including reactions to medications or anesthesia
Health and dental insurance information
Details on past surgeries or hospitalizations, if any
Contact information for your family physician
Patient Medical History Form
Questions before you submit?
If you’re unsure how to answer something, our team is happy to help.