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Internal Use Only: __/__/___ #/Name___ FMX___ BWX___ Other___ DENTAL HEALTH AND APPEARANCE Reason for visit: ___ Name of previous dentist: ___ Location: ___ Permission to contact previous dentist
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Start by gathering your dental records and information about your oral health history.
02
Make a list of any current dental issues you are experiencing.
03
Assess your daily oral hygiene routine: brushing, flossing, and mouthwash use.
04
Evaluate your diet and its impact on your dental health, including sugary snacks and drinks.
05
Consider any cosmetic concerns, such as tooth discoloration or alignment issues.
06
Document any dental appointments you've had and treatments received.
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Fill out any required forms with clear and honest information about your dental habits and concerns.

Who needs dental health and appearance?

01
Anyone seeking to improve their oral health and appearance.
02
Individuals preparing for dental consultations or treatments.
03
Patients who have specific concerns about their dental aesthetic.
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People looking to maintain good oral hygiene and prevent future issues.
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Dental health and appearance refer to the overall condition of an individual's oral health, including the cleanliness, structure, and aesthetics of teeth, gums, and surrounding tissues.
Individuals who seek dental insurance or health assessments may be required to file dental health and appearance reports, typically including patients looking for orthodontic treatment or certain medical evaluations.
To fill out dental health and appearance, individuals must provide details about their dental history, current conditions, any treatments received, and evaluations from dental professionals.
The purpose of dental health and appearance documentation is to ensure accurate assessment for dental care, to evaluate eligibility for treatments, and to maintain records for insurance purposes.
Information that must be reported includes personal dental history, current oral health status, any previous treatments, and specific concerns or issues related to dental health.
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