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SC Carolina Dental Alliance Medical History Form 2015
Get SC Carolina Dental Alliance Medical History Form 2015-2024
Birth: / / Today s Date: / / Although dental personnel primarily treat the area in and around your mouth, your mouth is part of your entire body. Health problems that you may have, or medication that you may be taking, could have an important interrelationship with the dentistry you will receive. Thank you for answering the following questions. Are you under a physician s care now? Yes No If yes Have you ever been hospitalized or had a major operation? Yes No.
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