Patients are often confused as to the
reasons why they need to fill out medical and dental history forms. People
often do not realize how their dental health affects their physical health and
how their physical health affects their dental health.
Dentist can help
you become healthier by not only examining the inside of your mouth but also by
helping you understand the mouth-body connection!
Dental exams can reveal gum
disease, cavities, oral
cancer, poor oral health conditions that are linked to diabetes,
heart disease and poor overall health. Because of how these risk factors are
related to each other you will be asked additional questions regarding your
The answers to these questions help us determine risk factors to
help us provide you with better treatment recommendations that are SPECIFIC TO
YOU. We can teach you what risk factors affect YOUR health. We will
do all we can to help you decrease your chances for heart disease, diabetes and
other health problems.
In addition many
medications have side effects that affect oral health. Two out of every
five patients take some kind of medication that could have a dental related side
effect! With age, this fact doubles.
Fill out the medical form in
the convenience of your home.
Please take the time to complete
Patient Information Form
Notice of Privacy Practices
You can send these forms by:
Mail them to us before your appointment:
1415 Sage Street, Gering NE 69641
Bring them with you to your
We will have you sign and date them at your first
will allows us to serve you faster and more efficiently.
prepared to provide us with:
Present medical condition
Problems with medications
Changes in any medication
List of current medication and
over the counter medications
Last visit to doctor
Are you taking a blood thinner?
When you take a blood thinner, there are concerns that you may
bleed unusually heavily after an extraction or having your teeth
cleaned. It is important that your doctorís office contact us
with a recent INR result before you have a cleaning, root
planing, or any kind of dental surgery including extraction or
gum surgery. The INR result helps decide whether we can do the
procedure with a high level of safety. We canít stress enough
that our office must have good communication with your doctor
to insure the greatest safety for you.
Working together we can choose
the treatment most appropriate for you!
Please click here for: Medical
Please click here for: Social
History/Patient Information Form