Eaglesoft Medical History

  • Although dental personnel primarily treat the area in and around your mouth, your mouth is a part of your entire body.

    Heath problems that you may have, or medication

  • Do you have, or have you had, any of the following?

  • To the best of my knowledge, the questions on this form have been accurately answered. I understand that providing incorrect information can be dangerous to my (or patient's) health. It is my responsibility to inform the dental office of any changes in medical status.