Patient Medical History Update

Barnes Dental

Please correct the errors described below.

Although dental personnel primarily treat the area in and around your mouth, your mouth is part of your entire body. Health problems that you may have, or dedication that you may be taking, could have an important interrelationship with the dentistry you will receive. Thank you for answering the following questions.

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.

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