Welcome to Cary Dental Associates
Please complete and submit this form prior to your first visit. We look forward to working with you in maintaining your dental health.
(Please bring a copy of your Dental Insurance Card. This may be different than your medical carrier. Please verify.)
(Please have x-rays forwarded to email@example.com prior to your first visit or new sets will be taken)
Cary Dental Associates, LLC
Eaglesoft Medical History
Although dental personnel primarily treat the area in your mouth, your mouth is a part of your entire body. Please list any health problems you may have or any medications that you are taking.
Women: Are you
Are you allergic to any of the following?
Do you have, or have you had any of the following?
To the best of my knowledge, the questions on this form have been accurately answered. I understand that providing incorrect information can be dangerous to my (or patient's) health. It is my responsibility to inform the dental office of any changes in medical status.
Analyze Your Own Smile
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