Family History Discovery
Please choose any condition that applies to your parents:
High Blood Pressure
Are both of your parents still alive?
At what age were they diagnosed with these conditions?
Do you recall your parents taking medications?
Do you have siblings?
Are they also suffering from the same symptoms?
To the best of my knowledge, all of the preceding answers are correct. If I have any changes in my health status or if my Medications change, I will inform the dentist and the staff at the next appointment without fail.*
Should be Empty: