List of All Medications
Please supply a complete and accurate list of all medications and drugs you are currently taking. This includes over-the-counter medications and herbal supplements.
You may print a copy of our medical history form from this website. If you cannot bring paperwork of your medical history, we will give you a brief form to fill out. It is important we have all your information, including allergies, prior surgeries, and any medical conditions.
Dental Insurance Information
If you have one or more dental benefit plans, you need your plan ID cards, so we can confirm coverage and determine benefits. Although we do not participate with any medical plans, some procedures require submission to your medical plan before your dental plan will cover them. Please also bring your medical insurance card with you. We need the subscriber's name, date of birth, and social security number if possible.
We require a driver's license or some form of official identification and your SSN. If you object to this or have no SSN or means of identification, we will not turn you away.
We request a good current phone number to contact you in the rare case you appointment must be changed. This only happens for unusual circumstances, such as severe weather preventing the staff from coming into our office.