Call now to make an appointment! (281) 491-4545 info@ofsih.com

HEALTH HISTORY FORM

Although dental personnel primarily treat the area in and around your mouth, your mouth is a part of your entire body. Health problems that you may have, or medication that you may be taking, could have an important interrelationship with the dentistry you will receive. Thank you for answering the following questions.

Women

Are you allergic to any of the following?

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

Sending
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.

I' felt no pain!

J. Bernard

I will be back and refer loved ones to the practice!

S. Sanchez

Great Professional Staff

M. Guidry

 

COME TO OUR PRACTICE

L.T. Johnson, DDS
4724 Sweetwater Blvd. #105
Sugar Land, TX 77479
3600 Kirby Drive
Suite F
Houston, Texas 77098
 

 

OPERATING HOURS

Monday to Friday
9:00am - 5:00pm

AREAS WE SERVE

- Sugar Land, TX
- Missouri City, TX
- Stafford, TX
- Richmond, TX
- Houston, TX
- Surrounding Areas

 

 

 

CONTACT US

Email: info@ofsih.com
Phone: (281) 491-4545