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    AIDS/HIV PositiveHay FeverOsteoporosisAnemiaHeart DiseasePacemakerArthritisHeart MurmurRadiation TreatmentArtificial JointsHepatitis A B CRheumatic FeverAsthmaHigh Blood PressureS.T.D.sBleeding DisordersKidney DiseaseSinus ProblemsCancerLiver DiseaseSleep ApneaDiabetesLung DiseaseStrokeEpilepsyLyme DiseaseTuberculosisFaintingMental DisordersThyroid DiseaseGlaucomaNervous DisordersNone of the above

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    YesNo

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    yesNo

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    To the best of my knowledge the above information is correct. If I ever have any change in my health, I will inform the doctoror hygienistat my next appointment without fail

    How oral health affects general healthThe dangers of silver (mercury) fillingsThe link between gum disease and heart diseaseLaser gum therapyThe benefits of digital x-raysDental implantsStraightening teeth with InvisalignCosmetic dentistryTeeth WhiteningOther

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