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.
Notepad of 100 sheets, 8.5" x 11" Copyright year: 2021
Children (S70721) and Spanish (S50121) forms are also available, as well as a downloadable form (S50021T) for posting on practice web sites.