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

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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