Some medicines may interfere with your dental treatment or react with medicaments used by your dentist. It is important that your dentist knows precisely what medications (if any) that you are taking.
Please provide details (including dose and frequency) of any medicine or medication that you are currently taking, or have been taking recently.
In signing this form I acknowledge that this represents an accurate medical history.
I will advise my dentist of any changes to my medical history in the future.
I understand that all medical details will be treated with complete professional confidentiality. I have read the privacy document provided by this practice.
I GIVE / DO NOT GIVE Absolute Dental permission to release information to the following third parties: