RETURN THIS COVER SHEET WITH YOUR MEDICAL HISTORY 2026

1. Click ‘Get Form’ to open it in the editor.
2. Begin by entering your name, date of birth (DOB), and the date you completed the form at the top of the cover sheet.
3. Carefully review each section regarding your medical history. For each question, select 'YES' or 'NO' as applicable, ensuring full disclosure for accurate care.
4. In the pharmacology section, list any medications you are currently taking, including over-the-counter drugs and supplements. Be thorough to assist your dental provider.
5. Complete all sections related to specific health conditions, such as respiratory or cardiovascular issues. If you answer 'YES', provide additional details where prompted.
6. Once finished, save your document and either print it to bring to your appointment or email it back if preferred. Ensure it's submitted at least 7-10 days prior if mailing.

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