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PATIENT INFORMATION AND MEDICAL HISTORY Name:___ Date:___ Address:___ City:___ State:___ Zip:___ Phone:___ Email:___ Date of Birth:___Age:___Sex:___ How did you hear about us? ___MEDICAL HISTORY:
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The mallardcreekdentalcom09medical-history-fill-in-themedical history form is a form that collects information about a patient's medical history.
All patients who visit Mallard Creek Dental are required to fill out the medical history form.
Patients can fill out the medical history form online or in person at the dental office.
The purpose of the medical history form is to provide the dental staff with important information about the patient's health history.
The medical history form typically asks for information about medical conditions, medications, allergies, and past surgeries.
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