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Full Medical Form

Full Medical Form PDF

  • Although dental personnel primarily treat the area in and around the mouth, your mouth is a part of your entire body. Health problems that you may have, or medication that you may be taking could have an important interrelationship with the dentistry you receive. We thank you for your cooperation in answering the following questions.
  • To the best of my knowledge the above information has been accurately answered. I understand that providing incorrect information can be dangerous to my health. It is my responsibility to inform the dental office of any medical changes.


PASSIONATE ABOUT YOUR TEETH


EMERGENCY DENTAL CARE

Call us now if you are experiencing a dental emergency,
we will respond swiftly and be happy to assist you.


613-746-6666





Copyright Dr. Sara Syed Dentistry. All rights reserved.






Copyright by DR. SARA SYED 2019. All rights reserved. Site by SKYFALL BLUE