Medical History

Endodontic Associates in Framingham,P.C.

Are you in good health now?

If no, please explain:
Are you under the care of a physician for a current medical condition?
Does your physician require you to take ANTIBIOTICS for your dental visits (PRE-MED)?
If yes, for what condition?
Are you allergic to LATEX (will the doctor’s latex gloves cause your skin to break out)?
Do you have any ALLERGIES (medications, food, environmental)?
If yes, please list:
Are you currently taking any MEDICATIONS?
If yes, please list:
Are you currently PREGNANT?
If YES, how many weeks?
Are you taking birth control?