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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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$19.95
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$29.95
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Member: $19.95
Retail: $29.95

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