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.
An additional Patient Screening Form is
now included to assess patients for possible symptoms of COVID-19 in advance of
their office visit. The form includes lines for pre-appointment and in-office
responses that can be used to evaluate if a deeper discussion with the dentist
is needed before treatment.
Children (S70721) and Spanish (S50121) forms are also
available, as well as a downloadable form (S50021T) for posting on practice
count: 2 notepads of 100 sheets each, 8.5" x
Copyright year: 2021