What is it about your teeth/bite/smile that has brought you to see us?
Does the patient currently have, or has the patient ever had any of the following?
I understand the information that I have given is correct to the best of my knowledge, that it will be held in the strictest of confidence, and it is my responsibility to inform this office of any changes in my child's medical status.
I verbally reviewed the medical/dental information above with the patient named herein.
1816 Eagle Drive, Woodstock, GA 30188