William E. Rockson DMD, P.C.

General and Cosmetic Dentistry


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Patient Information Form

Patients are often confused as to the reasons why they need to fill out medical and dental history forms. People often do not realize how their dental health affects their physical health and how their physical health affects their dental health.

Dentist can help you become healthier by not only examining the inside of your mouth but also by helping you understand the mouth-body connection!

Dental exams can reveal gum disease, cavities, oral cancer, poor oral health conditions that are linked to diabetes, heart disease and poor overall health. Because of how these risk factors are related to each other you will be asked additional questions regarding your health.

The answers to these questions help us determine risk factors to help us provide you with better treatment recommendations that are SPECIFIC TO YOU. We can teach you what risk factors affect YOUR health. We will do all we can to help you decrease your chances for heart disease, diabetes and other health problems.

In addition many medications have side effects that affect oral health. Two out of every five patients take some kind of medication that could have a dental related side effect! With age, this fact doubles.

Fill out the medical form in the convenience of your home.You will present this completed form to us upon your arrival.