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Where artistry and dentistry cOME together
CHILD MEDICAL HISTORY FORMS
It is important that you schedule your appointment first and then fill up the medical history forms part 1 and part 2 both.
I understand that the information that I have given is correct to the best of my knowledge, that I will be held in the strictest of my confidence and it is my responsibility to inform Briarcliff Smile Design dental office of any changes in my child's medical status.
I authorize the dentists team to perform the necessary dental services my child may need.
NOTE: The Parent or Guardian who accompanies the child is responsible for payment at time of service unless prior arrangements have been approved.
Our office is HIPAA Compliant and committed to meeting or exceeding the standards of infection control mandated by OSHA, the CDC and the ADA.
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