New Patient Form

Are you in discomfort?

Are any of your teeth sensitive?

Do your gums bleed or hurt?

Are you satisfied with your teeth's appearance?

Are you currently seeing any medical specialists?

Do you smoke or use smokeless tobacco (including e-cigarettes)?)

Have you had a joint or heart valve replacement?

Have you been prescribed antibiotic premedication? (if yes, please take as prescribed prior to your exam)

Do you use a CPAP?

Do you have any drug allergies?

Autoimmune disease:

Do you take or have you taken bisphosphonates?

Are you pregnant?

Have you taken any medication in the last 12 months?