Medical History Questionnaire for children

Fill in the form

Dear patient,

Welcome to Erasmus Dental Care, the dental practice where professionalism and care for your child are of utmost importance.

To provide the best possible care, we need to be informed about your child’s  recent medical situation. This information is crucial for accurate dental assessment and treatment without compromising their health. Additionally, it’s important for the healthcare provider to be aware in order to take appropriate precautions. Without a completed and signed health questionnaire, no treatment will be provided. Also, if any changes occur in your child’s health or medication after completing the form, please inform the healthcare provider. If your child has a medication list from their physician, please request it and provide us with a copy.

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