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Boulder Periodontics Medical History Name: DOB: Are you allergic to any of the following? Aspirin Codeine Acrylic Metal Latex Local Anesthetics Iodine/Shellfish Other: For the following sections,
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To fill out Boulder Periodontics Medical History, follow these steps:
02
Start by entering your personal information such as your name, date of birth, contact information, and address.
03
Provide your dental insurance information, including your insurance company, policy number, and group number if applicable.
04
Fill out the section on your medical history, including any chronic conditions, past surgeries, allergies, or medications you are currently taking.
05
Answer the questions related to your dental history, such as previous gum diseases, tooth extractions, or dental implants.
06
Indicate any specific concerns or issues you would like the periodontist to address during your visit.
07
Sign and date the form to confirm the accuracy and completeness of the provided information.
08
Return the filled-out medical history form to Boulder Periodontics before your appointment.

Who needs boulder periodontics medical history?

01
Anyone visiting Boulder Periodontics for the first time or as a returning patient needs to fill out the Boulder Periodontics Medical History form. This form helps the periodontist understand your overall health, any pre-existing medical conditions, and any previous dental treatments that may impact your periodontal health. It is an essential document for proper diagnosis, treatment planning, and ensuring your safety and well-being during dental procedures.
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Boulder periodontics medical history is a record of a patient's dental and medical information, including past procedures, medications, and health conditions.
All patients receiving treatment at Boulder periodontics are required to provide their medical history.
Patients can fill out the Boulder periodontics medical history form provided by the dental office, which includes questions about their health, medications, allergies, and previous dental procedures.
The purpose of the Boulder periodontics medical history is to help the dental team understand the patient's overall health and any factors that may affect their dental treatment.
The Boulder periodontics medical history form typically asks for information such as current health conditions, medications, allergies, previous surgeries, and past dental treatments.
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