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Adult Orthodontic Medical History PATIENTDr. qMr. qMrs. qMiss qMs. qRESIDENCE TEL: ___ BUSINESS TEL: ___NAME: ___CELLULAR: EMAIL: ___BIRTHDAY: ___REFERRED BY: ___AGE: ___DENTIST\'S NAME: ___ADDRESS:
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How to fill out adult orthodontic medical history

01
To fill out an adult orthodontic medical history form, follow these steps:
02
Start by providing your personal information including your full name, date of birth, contact information, and address.
03
Next, disclose any previous or existing medical conditions you may have such as heart conditions, diabetes, respiratory problems, etc.
04
Specify any known allergies or sensitivities to medications, latex, or metals that may be relevant to your orthodontic treatment.
05
Mention any current medications, supplements, or vitamins you are taking, as certain medications can affect orthodontic procedures.
06
Provide details about any previous surgeries or hospitalizations that are significant to your orthodontic treatment.
07
Mention any previous orthodontic treatments you may have received including braces, retainers, or orthodontic appliances.
08
If you have any existing dental conditions or concerns, describe them in detail. This may include gum disease, tooth decay, missing teeth, etc.
09
If you have dental insurance, provide your insurance information including the policy number and contact details.
10
Lastly, sign and date the form to indicate that the information provided is accurate and complete.

Who needs adult orthodontic medical history?

01
Adult orthodontic medical history forms are required for individuals who are seeking orthodontic treatment as adults.
02
It is necessary for any adult who is considering braces, aligners, or any other orthodontic procedures to fill out a medical history form.
03
This form helps the orthodontist understand the patient's overall health, any pre-existing conditions, and any potential risks that may affect the treatment.
04
By collecting this information, the orthodontist can tailor the treatment plan to meet the specific needs and ensure the safety of the patient during the orthodontic procedures.
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Adult orthodontic medical history is a comprehensive record of an adult patient's past and present medical conditions, including any treatments they have received, medications they are currently taking, and other relevant health information that may affect orthodontic treatment.
Typically, adult patients seeking orthodontic treatment are required to file an adult orthodontic medical history as part of their initial assessment and treatment planning process.
To fill out adult orthodontic medical history, patients should accurately complete a designated medical history form provided by their orthodontist, ensuring they include information about all medical conditions, dental history, medications, allergies, and any other relevant health information.
The purpose of adult orthodontic medical history is to provide orthodontists with essential information to evaluate a patient's overall health and specific conditions, which can influence treatment options and outcomes.
Information that must be reported includes current and past medical conditions, surgical history, medications, allergies, family medical history, dental issues, and any prior orthodontic treatments.
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