Get Health History Questionnaire

Completing the Health History Questionnaire is a crucial step in ensuring your dental health. This guide will provide you with clear, step-by-step instructions to help you fill out the questionnaire accurately and efficiently online.

Follow the steps to complete your Health History Questionnaire online

1. Press the ‘Get Form’ button to access the form and open it in your digital device's editor.
2. Begin by entering your name, including your last name, first name, and middle initial. Make sure to include your birthdate in the designated field.
3. In the personal health history section, respond to the questions regarding tobacco use and excessive drinking by selecting 'Yes' or 'No'.
4. Indicate if you have taken specific medications by checking 'Yes' or 'No' for each listed option, including bisphosphonates and dietary supplements.
5. Next, review the allergy section. Circle 'Yes' or 'No' for each medication and provide any additional allergies in the space provided.
6. Move to the dental history section, and fill in how long it has been since your last dental visit and the date of your last complete dental exam.
7. Answer the questions regarding current dental problems, pain, denture usage, anxiety towards dental treatment, and any sensitivity or issues with your teeth.
8. Proceed to the medical history section. Indicate whether you have any current health problems and if you are under a physician's care, providing details where necessary.
9. Respond to the list of medical conditions by checking 'Yes' or 'No' for each condition that applies to you.
10. If applicable, respond to the specific questions for women regarding pregnancy, nursing, or birth control.
11. Finally, add any other medical or dental information you believe is important. You will also need to review and confirm the accuracy of your provided information before signing.
12. After thoroughly checking your responses, you can save the changes, download, print, or share the completed form as needed.

Complete your Health History Questionnaire online today for a comprehensive assessment of your dental health.