0
eStore Alert: Save 15% on ADA Store products like Dental Implants with promo code 23634W.
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
ADA Patient Health History Form Image 2
ADA Patient Health History Form Image 2

ADA Patient Health History Form

S50021
Member
$19.95
Retail
$29.95
PacksMemberRetailSave
1 - 4$19.95$29.95
5 +$15.96$23.9620%
or sign up to add to cart.
Member: $19.95
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