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.

OUR LOCATIONS

Oral and Facial Surgery Institute of Sugar Land
4724 Sweetwater Blvd. #105
Sugar Land, TX 77479
Houston Oral Surgery and Dental Implant Center
6560 Fannin St. #1522
Houston, TX 77030
Oral Facial Surgery Specialist at The Woodlands
10857 Kuykendahl Rd. #150
The Woodlands, TX 77382

AREAS WE SERVE

  • Sugar Land
  • Missouri City
  • Stafford
  • Richmond
  • Houston
  • The Woodlands
  • Rosenberg
  • Surrounding Areas
Email: info@ofsih.com
Phone: (281) 491-4545

OPERATING HOURS

OPERATING HOURS

Monday to Friday
7:00am - 3:00pm