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Medical/dental history forms
Medical history forms (see download)
To help us compile a general medical history , you will receive a medical history form which will help us answer the following questions:

- Your current and past dental situation
- Any dental or jaw treatment or procedures
- Current symptom profile
- Past and current diseases and/or diagnoses
- Medications taken
- Known allergies and intolerances
- Family history of disease

Patients with multiple chemical sensitivity (MCS) or suspected MCS will also receive the environmental questionnaire created by Dr. Miller (Qeesi) (see download).