Medical Information

Dr. Aaron Tropmann & Dr. Gary Oyster

Please correct the errors described below.

Although a dentist primarily treats the area in and around the mouth, your mouth is a part of your entire body. Health conditions that you may have or medications you may be taking, could have an important interrelationship with the care that you will be receiving.

Women

AUTHORIZATION AND RELEASE:

I certify that I have read and understand the above information to the best of my knowledge. The above questions have been accurately answered. I understand that providing incorrect information can be dangerous to my health. I authorize the dentist to release any information including the diagnosis and the records of any treatment or examination rendered to me or my child during the period of such dental care to third party payors and/or health practitioners. I authorize and request my insurance company to pay directly to the dentist, insurance benefits otherwise payable to me. I understand that my dental insurance carrier may pay be less than the actual bill for services. I agree to be responsible for payment of all services rendered on my behalf or my dependents.

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