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Dentist Office


Dentist Office

Thank you and please call our office 215-560-8104 or email to if you have any questions.

Medical History

Have you ever had any of the following medical conditions or allergies?
Do you have any other health problems?
Are you taking any medications at this time?
Have you been admitted to a hospital in the last 2 years?
Are you under care of a physician?
Do you use tobacco?
Do you consume alcoholic beverages?
Have you ever taken Fosamax, Boniva, Actonel or any other medications containing bisphosphonates?
Have you ever taken a diet drug, such as Fen-Phen?
Women: Are you pregnant?
Women: Do you take birth control medications?
Women: Are you nursing?

Thanks for submitting!

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