This form is designed for the provider who wishes to collect more in-depth dental health history that is not covered on the Confidential Health History Form, as well as assess the patient’s oral health and/or cosmetic concerns. It can be completed prior to or at the beginning of the initial appointment.
This form should be reviewed by all providers working with the patient with the goal to address specific concerns expressed on the form with the patient. If this form is completed and received by the practice prior to the day of the patient’s first appointment, relevant information completed on the form about the new patient should be shared in the practice’s morning meeting.