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New Patient

! Please fill out our new patient questionnaire so we can better understand your dental needs.

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Thank you for completing our health history form. Your responses have been submitted. We will follow up with you to schedule an appointment or you can call us at 306-343-5566 to book an appointment.

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Do you have or have you ever had:

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Do you have or have you ever had:

Are You:

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List all medications, supplements, and or vitamins taken within the last two years.

Drug Purpose

PLEASE ADVISE US IN THE FUTURE OF ANY CHANGE IN YOUR MEDICAL HISTORY OR ANY MEDICATIONS YOU MAY BE TAKING.

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