Medical / Dental Questionnaire

Please fill out the following form.

Please indicate if you have any of the following conditions for which you have been treated:
Are you in good heatlth?
Do you have any history of major illness?
Are you taking any drugs or medication?
Are you allergic or sensitive to any drugs?
Do you need to take antibiotics before dental work?
Do you smoke?
Are there any other medical conditions we should know about?
Have you ever injured your face, mouth, teeth?
Have you ever sucked a thumb or finger?
Do you have any difficulty chewing foods?
Do you play any contact sports?
Was your last dental check-up within 6 months?
Do you have any jaw joint (TMJ) problems?

Thanks for submitting!