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ORTHODONTIC HEALTH HISTORY FORM Patients Name:___ Date of Birth: ___Patients Address: ___ Town:___ Phone Numbers: Home: ___ Patient cell:___ Dad Cell:___ Mom Cell:___ Email:___ 1. Has the patient
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How to fill out orthodontic health history form
How to fill out orthodontic health history form
01
Obtain the orthodontic health history form from your orthodontist's office.
02
Fill out your personal information including name, address, phone number, and date of birth.
03
Provide information on your general health, any medication you are taking, and any medical conditions you have.
04
Answer questions about your dental health, including past dental treatments and any current issues.
05
List any allergies or sensitivities you have to medications or materials used in dentistry.
06
Sign and date the form to confirm that the information provided is accurate.
Who needs orthodontic health history form?
01
Anyone who is undergoing orthodontic treatment or considering orthodontic treatment needs to fill out an orthodontic health history form.
02
This form helps the orthodontist understand the patient's overall health status and any factors that may impact the orthodontic treatment.
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What is orthodontic health history form?
The orthodontic health history form is a document that collects detailed information about a patient's dental and medical history to assess their eligibility and needs for orthodontic treatment.
Who is required to file orthodontic health history form?
Patients seeking orthodontic treatment are required to fill out the orthodontic health history form, including both adults and guardians of minors.
How to fill out orthodontic health history form?
To fill out the orthodontic health history form, patients should provide accurate personal information, details of their dental history, any current medical conditions, medications, and any allergies.
What is the purpose of orthodontic health history form?
The purpose of the orthodontic health history form is to ensure the orthodontist has all relevant information to develop the best treatment plan tailored to the patient's specific needs.
What information must be reported on orthodontic health history form?
The form typically requires reporting personal details, dental history, medical history, medications, allergies, and any previous orthodontic treatments.
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