Appointments: (614) 235-5560
Appointments: (614) 235-5560
Due to COVID-19, we will be conducting exams and consultations via video conferencing, whenever possible. You will receive further instructions, if a video conference is necessary. Please call our office for more information. Click here to learn more about how COVID-19 has affected the practice of dentistry in Ohio.
Please fill out this form COMPLETELY. Incomplete forms must be re-submitted. Please list all allergies, medications, vitamins and supplements you are currently taking. If needed, please provide us with a list of your current medication names, dosages and frequencies. Please ensure that this medication list includes your name, date of birth and legal signature.
HS Dental Patient Medical History (pdf)
DownloadPlease review our HIPAA privacy policy and sign the acknowledgement form. Please also review and sign our virtual services consent form.