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  • 5284 Lyngate Court, Burke, VA 22015

  • Mon-Thur: 8am-5pm / Fri: 8am-12pm

Supplemental History Questions For an Adolescent Patient








We recognize that patients may engage in certain behaviors/activities that can have significant consequences on their oral health and/or general health. In addition, medicines that we use to treat oral conditions may interact with drugs (prescription, over-the-counter, or recreational) and other substances a patient might be using. Therefore, we encourage our adolescent patients to answer all of the following questions truthfully. If you prefer not to answer an item, we hope you will discuss any concerns confidentially with your dentist.

Do you have any history of: