Medical History Form

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Medical History Form


We invite you to complete this two-page patient information form in advance of your dental visit. You may print it out and fill in your answers in ink, or you may input your answers directly on the form on your computer. If you are hand-writing, please print. Should you have any questions please contact our office at 317-462-7223. Thank you.

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Our Location

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Hours of Operation

Our Regular Schedule

Primary Location

Monday:

7:00 am-4:00 pm

Tuesday:

7:00 am-4:00 pm

Wednesday:

7:00 am-1:00 pm

Thursday:

11:30 am-5:30 pm

Friday:

Patient and Adminstrative hours 8:00am - 12:00pm

Saturday:

8:00am - 1:00pm one time per month

Sunday:

Closed