Medical History

Confidential Medical History Form 

This form can be printed and brought to your initial appointment.

During your first dental visit, your dentist will ask for a thorough medical history. We ask you to bring a completed one with you as it saves time doing it during your appointment. This includes questions about lifestyle (such as smoking or involvement in high-risk sports) and family medical history. This history, combined with the results of your initial clinical examination, will help to assess your immediate dental-care needs and recommend the best treatment approach.

What kind of health information should I share and how specific should I be?

Mention everything about your health, even if you don’t think it relates to your mouth. If you have had surgery or a major illness, be sure to include this information in the medical history of your patient information section.

Many diseases can have significant effects on your mouth and teeth, and researchers continue to discover ways in which oral health is related to overall health. Diabetes, for instance, can increase the risk of periodontal (gum) disease.

Please include any of the following if relevant:

Recent heart surgery (within the last six months)
Artificial heart valve(s)
Congenital heart defect
History of rheumatic fever
History of heart murmur/mitral valve prolapse
Knee, joint or hip replacement surgery
Previous bacterial endocarditis
Current or past smoking
Any allergies (including latex allergy)
If you are pregnant
Any health problem or medical condition for which you are currently being treated
Should I tell my dentist about any medications I am taking?

Information about medications you are currently taking can be vital to your health, especially in an emergency. Some medications cause dry mouth, which can increase the risk of cavities. Other health conditions may require the dentist to change the type of anesthesia given. Your dentist also will want to make sure that any medications he or she prescribes don’t interact with medications you already are taking, either prescription or over-the-counter. If you are visiting your dentist for the first time, bring along a current list of medications just to be sure your dentist has an accurate record.

How often should I update my medical history?

After your first visit, be sure to keep us informed any time there is a change in your current health status. The dentist and hygienist will ask you at every appointment if there are any changes since your last visit. Let your dentist also know if you are pregnant, have developed allergies or are a smoker. Depending on your health status at the time of your visit, different treatment alternatives, or even delaying treatment, may be recommended.

How can I be assured my medical history and records will remain private?

You dentist cannot release any diagnosis or visit information without your consent.