Health Care History

Filling out this form

Answering these questions will help your doctor understand your health and how best to treat you.

If you need help filling out this form:

• If you need help filling out this form:
  
  OR
  
  
• Call the office at 212-751-1333 before your appointment and someone can help you over the phone.

Click here to download the Health Care History Form.

You can fill out the form on your computer and e-mail the completed form to info@madisonavenuedental.com  If you choose you may also fill out the form and bring it with you at the time of your appointment.

Need Adobe Acrobat Reader?

If you do not have a copy of Acrobat Reader you can get one for free by clicking on the icon 'Get Acrobat® Reader'. This will take you to Adobe's website and enable you to download the Acrobat program to your computer.