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SOCIAL HISTORY

As a patient you have the choice too:

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Fill the social history form out and send it to us by fax 308-436-3451.

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Download the social history form, fill it out at home and mail it to us one week before your appointment.

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Or wait until your first appointment and fill this information out at our office.  

     If you choose to submit this completed form beforehand it will assure faster processing of your paperwork at your appointment. So when you arrive for this appointment all you will have to do is sign and date this form to validate that it is accurate and up to date. 

 Fill out the patient information in the comfort of your own home at your convienence.

Click here to fill out: Social History/Patient Information Form

(Warning there is no encryption system protecting the confidentiality of any material that you may send to us.)

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PLEASE NOTE: The information contained herein is intended for educational purposes only.  It is not intended and should not be construed as the delivery of dental/medical care and is not a substitute for personal hands on dental/medical attention, diagnosis or treatment.  Persons requiring diagnosis, treatment, or with specific questions are urged to contact your family dental/health care provider for appropriate care.
This site is privately and personally sponsored, funded and supported by Dr. Peterson.  We have no outside funding.
Confidentiality of data including your identity, is respected  by this Web site. We undertake to honor or exceed the legal requirements of medical/health information privacy that apply in Nebraska.

Copyright 1998-2017 Family Gentle Dental Care, all rights reserved.