New Patient Forms
Filling these in at home rather than in the waiting room means more of your appointment is spent on your teeth.
Download
Complete these before your first visit
Please download, print and complete the forms below, then bring them with you to your first appointment. If you cannot print them, arrive about fifteen minutes early and we will provide copies.
If anything on the forms is unclear, leave it and we will go through it together at your visit.
Also bring
What to have with you
- Photo identification
- Your dental insurance card, if you have coverage
- A list of all medications and supplements you take, including over-the-counter ones
- Details of any medical conditions, allergies or recent surgery
- Any recent dental x-rays from a previous dentist, if you have them
- The name and contact details of your physician, if you have significant medical history
Medication and medical history genuinely change how we treat you, particularly blood thinners, bisphosphonates and diabetes medication. Please do not leave anything off.
Why we ask
What your medical history changes
The health questions on the forms are not administrative. Several common medications and conditions directly change how treatment is planned and carried out, and finding out mid-procedure is considerably worse than knowing beforehand.
Blood thinners affect bleeding after extractions and gum treatment. Never stop taking them before a dental appointment on your own initiative; tell us instead and we plan around them. Bisphosphonates and related bone medications, often prescribed for osteoporosis, affect how the jaw heals after extractions and implant surgery. This matters enough that it changes the treatment plan. Diabetes affects both susceptibility to gum disease and healing afterwards. Well-controlled diabetes is rarely an obstacle; knowing about it changes what we monitor. Heart conditions, joint replacements and immune suppression can require antibiotic cover before certain procedures. Allergies, including to latex and to specific anaesthetics or antibiotics.Include everything
Over-the-counter medicines and supplements count. Some, including high-dose fish oil and certain herbal preparations, affect bleeding. If you are pregnant, or think you might be, tell us, because it affects x-rays and the timing of elective treatment.
Common questions
Questions we hear most
Do I have to print the forms?
No. If printing is inconvenient, arrive about fifteen minutes before your appointment and we will give you copies to complete in the office.
Why do you need my medical history for dental treatment?
Because many medical conditions and medications directly affect dental care. Blood thinners affect bleeding after extractions, some osteoporosis medications affect healing after implant surgery, and diabetes affects gum disease and healing. It is a safety matter, not paperwork for its own sake.
What should I expect at a first appointment?
A review of your history, x-rays where indicated, a cleaning, and a full examination by Dr. Mathew including gum disease and oral cancer screening. You will then hear what she found and what she recommends, with costs. Allow about an hour.
Can I complete the forms if I am booking an emergency appointment?
Do not worry about the forms in an emergency. Call (843) 970-3799 and come in. We will handle the paperwork around treating your problem.
Is my information kept confidential?
Yes. Patient information is handled in accordance with applicable privacy and health information regulations. See our privacy policy.
Do children need their own forms?
Yes, each patient needs their own set, completed by a parent or guardian for anyone under eighteen.
Ready when you are
Schedule your first appointment
New patients are welcome, and dental emergencies are seen the same day.