Dental and Medical Histories - Updates

In-depth, easily - updated history form

It is the dentist's responsibility to obtain a dentally relevant history from the patient. Such histories must be routinely reviewed to be sure that information is current. Our form makes it easy to comply.

Dental History - Our questions are arranged in alternating fashion - No/Yes, No/Yes. An answer out of sequence spotlights a possible problem.

Medical History - Our form is very detailed. Use a highlighter to focus attention on important responses; use a red pen to make notes. A medical "alert" label can be placed on the outside of the folder in the appropriate section 

Medical Updates - Changes in a patient's general health can be noted quickly. A section for the patient's and dentist's signature is provided.

• Accepted format for adults and children - exams or emergencies
• "Yes" and "No" answers cannot be overlooked
• Information on specific allergies and medications
• Premedication alert
• Review area
• Medical updates on same convenient form

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Sample Form in PDF format

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Privacy Policy

Stepping Stones to Success is designated as an Approved PACE Program Provider by the Academy of General Dentistry. The formal continuing dental education programs of this program provider are accepted by the AGD for Fellowship, Mastership and membership maintenance credit. Approval does not imply acceptance by a state or provincial board of dentistry or AGD endorsement. The current term of approval extends from 8/1/2009 to 7/31/2012.