Part 1: New Patient Questionnaire
Part 2: Medical History
Although dental personnel primary treat the area in and around your mouth, your mouth is a part of your entire body. Health problems that you may have, or medications that you may be taking can affect your treatment.
Part 3 : Privacy Agreement
We keep a record of the health care services we provide you. By my signature below, I acknowledge receipt of the Notice of Privacy Practices for Clearwater Dental. We will not disclose your record to others, unless you direct us to do so or unless the law authorizes or compels us to. Our Privacy Practices describes in more detail how your health information may be used and disclosed, and how you can access your information. You may ask to see and copy that record at any time.