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    • BLOG
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    • WHAT TO EXPECT
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  • CLEAR DENTAL EDUCATION

Dental History Form

Dental History Forminboundsquad2022-02-05T14:38:27-07:00

Patient Dental History

Gum and Bone

Please select all that apply to you:

Tooth Structure

Please select all that apply to you:

Bite and Jaw Joint

Please select all that apply to you:

Smile Characteristics

Please select all that apply to you:

Medical History

Do you or have you ever had an allergic or bad reaction to any of the following:

Please select all of the following that you have or have ever had:

Please select any of the following that apply to you:

Please advise the office in the future of any change(s) in your medical or dental history as well as medications you may be taking.

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#103, 4222 Gateway Blvd Edmonton, AB T6J 7K1
780-250-2728
info@clear-dental.ca


HOURS

Monday - Friday

8:30AM - 4:30PM

Saturday & Sunday

CLOSED

By Appointment Only

Treatments

Veneers
Dental Implants
Dental Crowns
Gum Grafting
Teeth Cleaning and Prevention
Teeth Whitening
Dental Bridges
Bone Grafting
Composite Restorations

Treatments

Crown Lengthening
Digital Smile Design
Extractions
Full Mouth Rehabilitation
Implant-supported Dentures
Periodontitis Treatment
Piezocision
Gum Rejuvenation
Peri-implantitis Treatment

Quick Links

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