Medical History Form

Gender
Are you currently under a physician’s care?
Are you pregnant? (Yes/No)
Do you smoke? (Yes/No, frequency)
Do you consume alcohol? (Yes/No, frequency)
Consent for Treatment*

Office Hours

Monday - Thursday 9:00 AM - 7:00 PM
Friday 9:30 AM - 6:00 PM
Saturday 10:00 AM - 4:00 PM
Sunday Closed (Emergency services available)

Book Appointment

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