Your health information is protected by law. Signing this form gives us your consent to use health information as necessary in an attempt to secure better insurance reimbursement.
Used to capture critical information about your head health history, any dental work you’ve had that relates to dental forces, pain symptoms and locations, accidents, lifestyle, habits, and so on.
This is a questionnaire that collects info about your health and headache history, including any previous diagnoses received, testing, past medication use, pain locations and severity, and so on.
We use this form to collect contact information for you and your spouse (if applicable) such as emergency info, and additional info about your dental / medical histories.
We use this form to collect information about your child under 18 (if applicable) such as emergency info, and additional info about your dental / medical histories.
Please read this document for info about how your health information may be used and shared, and how you can access this information. Your privacy is important to us!