Get the free Dental History Form

A patient intake form for dental history, collecting essential information about patients' previous dental visits, issues, and current oral health status.

How to fill out dental history form

How to fill out Dental History Form

1. Start by entering your personal information at the top of the form, including your name, date of birth, and contact information.
2. Provide details about your dental insurance, if applicable, including the provider and policy number.
3. List any current medications you are taking, including prescriptions, over-the-counter drugs, and supplements.
4. Indicate any allergies you have, especially to medications or dental materials.
5. Fill out any history of dental treatments, including past surgeries, orthodontics, or extractions.
6. Provide information about your oral hygiene routine, such as how often you brush and floss.
7. Answer questions about your dental habits, such as smoking or alcohol use.
8. Complete sections about family dental history, including any hereditary conditions.
9. Review the form for accuracy before submitting it to your dentist's office.

Who needs Dental History Form?

1. New patients visiting a dental office.
2. Current patients due for a dental check-up.
3. Patients with changes in their medical history or medications.
4. Individuals seeking specialized dental treatment.
5. Patients needing to update their records for insurance purposes.

People Also Ask about

How to check dental history?

In most cases, you must make a written request in order to obtain a copy of your patient chart. Some dental offices may have a request form or require you to sign for the file when you get it. To find out, call your dentist and ask what the request procedure entails.

What are the most common dental treatments historically?

Decaying or unhealthy teeth were treated with home remedies usually, but there was also professional help available. Barber surgeons cut hair, pulled teeth, applied leeches to cure diseases, and carried out simple surgeries. Today, gleaming white and even teeth are a sign of wealth.

How do you write dental notes?

Each patient's dental record should: Include results from any physical head/neck/oral cancer exam, periodontal and endodontic findings, the diagnosis and treatment plan as well as findings from occlusal and temporomandibular joint exams.

Are my dental records in a database?

Dental records are used to confirm the remains match the dental records already known. There is no database of your teeth like for finger prints or dna.

What is included in the dental history?

The dental history should include past dental difficulties, name and address of current or most recent treating clinician, chief complaint (including duration, frequency, type and intensity of any pain), relevant prior dental treatment, and attitude regarding teeth retention.

How to find dental history?

In most cases, you must make a written request in order to obtain a copy of your patient chart. Some dental offices may have a request form or require you to sign for the file when you get it. To find out, call your dentist and ask what the request procedure entails.

How to check dental history?

In most cases, you must make a written request in order to obtain a copy of your patient chart. Some dental offices may have a request form or require you to sign for the file when you get it. To find out, call your dentist and ask what the request procedure entails.

Are your dental records public?

Your Right to Obtain Access to Your Dental Records Thanks to HIPAA, you are the only person with the right to your dental and other medical records.

What is the history taking in dentistry?

The dental history is divided into five basic directions of questioning: localization, commencement, intensity, provocation, and duration. Localization – The doctor asks the patient to point out the offending tooth. Often the patient can point to or “tap” the offending tooth.

What is a dental clearance form?

Dental clearance is communication between a healthcare provider and a patient's dentist to validate that planned medical/surgical treatment is safe for the patient and to review the potential need for dental treatment before the medical/surgical treatment.

For pdfFiller’s FAQs

What is Dental History Form?

The Dental History Form is a document used by dental professionals to gather important information about a patient's dental health history, including past treatments, existing conditions, and any medications that may affect dental care.

Who is required to file Dental History Form?

Any patient seeking dental care, whether a new patient or a returning patient with significant changes in their medical or dental history, is required to file a Dental History Form.

How to fill out Dental History Form?

To fill out the Dental History Form, patients should provide accurate and complete information regarding their dental and medical history, including details about previous dental treatments, allergies, medications, and any ongoing health issues.

What is the purpose of Dental History Form?

The purpose of the Dental History Form is to help dental professionals assess a patient's dental and medical background, ensuring appropriate treatment and care while identifying any potential risks or allergies.

What information must be reported on Dental History Form?

The Dental History Form must report information such as previous dental procedures, chronic dental issues, current medications, allergies, medical history, family dental history, and any other relevant health concerns.