Medical History

MEDICAL HISTORY

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 ...

Are you allergic to any of the following?

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

Continued...

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.

PATIENT SIGNATURE

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COVID-19 UPDATE FROM DR. HABECKER AND HIS TEAM

Dear Patient Family,

The COVID-19 pandemic has been a difficult time for all of us. Many of you have been forced to wait for dental care and we appreciate your understanding while we kept our office closed to follow orders from the Governor's Office.

We are happy to say that we are opening our office for all patient treatment on June 1st, 2020. Our hours of operation will go back to normal, Monday-Thursday 8am - 5pm. We want you to know that there will be some changes at your next appointment. Please be patient with us as our protocols will inevitably change as new guidelines are released.

  • We ask that you use our parking lot as the waiting room.
  • Please wear a mask when you come into the office and leave it on until entering the treatment room. Homemade is acceptable.
  • Only the person receiving treatment should come in the building, all others will be asked to wait in the car if at all possible. The exception will be for our minor patients who may have one parent accompany them.
  • We will be asking you some questions when you arrive at the office and we will also be taking your temperature.
  • We will not be able to offer magazines, drinks, or toys at this time as they cannot be disinfected to our standards. Eventually this will change and we will be happy to offer our amenities once again.

These changes have been made to adhere to the latest CDC guidelines and for the benefit of our patients and our staff. We want you to know that our office has always taken the safety of our patients very seriously and that we will continue to follow the highest levels of sterilization and disinfection to keep you protected. If you would like more information on what measures we have taken we would be more than happy to answer any questions you may have.

We cannot say how excited we are to see all of our patients again and to provide for their dental needs. We look forward to seeing all of your smiling faces soon!

Dr. Habecker and Team