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Medical History

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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.

Are you under a physician's care now?
Have you ever been hospitalized or had a major operation?
Have you ever had a serious head or neck injury ?
Are you taking any medications, pills, or drugs?
Do you take, or have you taken, Phen-Fen or Redux?
Have you ever taken Fosamax, Boniva, Actonel or any other medications containing bisphosphonates?
Are you on a special diet ?
Do you use tobacco ?
Do you use controlled substances?
Women: Are you Pregnant/Trying to get pregnant?
Taking oral contraceptives?
Nursing?
Are you allergic to any of the following ?
  • Ameritas Life
  • Aetna
  • Argus Dental & Vision Plan (Aflac Benefit Solutions)
  • Careington Dental
  • Connection Dental Network
  • DenteMax
  • Dentegra Dental
  • Delta Dental
  • Florida Blue
  • Florida Combined Life
  • GEHA
  • Guardian
  • Humana PPO
  • Lincoln Dental
  • MetLife Dental
  • Principal Dental
  • Solstice Medicare
  • United Concordia Dental
  • UnitedHealthcare
  • Diverse Care – Sun Health & Dental Plan
  • Most PPO Dental Plans
  • Select HMO Plans (including Cigna, Aetna, and Guardian)
 
Insurance Information: We accept most PPO dental insurance plans and select HMO plans. We do not accept Medicaid plans or capitated insurance plans. Please contact our office at 954-530-5352 to verify your insurance benefits before your appointment
 

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Office Location - Fort Lauderdale