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ADA Patient Health History Form Image 0
ADA Patient Health History Form Image 0
ADA Patient Health History Form Image 0
ADA Patient Health History Form Image 1
ADA Patient Health History Form Image 1
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ADA Patient Health History Form Image 2

ADA Patient Health History Form

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Retail: $29.95
or sign up to add to cart.

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.

Sample