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S50021T

Downloadable ADA Patient Health History Form

Check out the ADA Online Store for Patient Health History Form, Downloadable. Buy online today.
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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.

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