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Keep us Updated About Any Health Changes!

Dental History Form

Your Mouth Works Hand in Hand with Your Body

Dental care is just one part of total health care. Because of that, we need to keep current with your entire health history, the good and the bad. Be sure to tell us if you…

  • have experienced any new allergies or sensitivities
  • have quit smoking (or started)
  • are taking any new medications, even over-the-counter drugs
  • have had any accidents or injuries
  • have been diagnosed with any illness or other medical condition
  • have had a baby

We may need to use an alternative local anesthetic, for example, or to administer an antibiotic before treatment, depending on what you tell us.

In turn, we’ll alert you to possible problems for you to discuss with your physician. Over 40 serious diseases—including bulimia, tumors and diabetes—can be detected in the mouth. The texture, color and condition of your tongue and gums give us clues to high blood pressure or osteoporosis.

That’s why we encourage you to make at least two dental appointments every year, especially if you don’t get annual physical exams. We’re here to make sure your teeth stay in great shape, along with the rest of your body.

About Dr. Chase & Dr. Kotula

Dr. Steven Chase, DDS & Jacqueline Kotula, DDS pride themselves on offering their patients the most comprehensive and sophisticated options for dental care in a comfortable and friendly environment. Their caring and talented dental family’s first priority is the well being of their patients. They strive to help their patients achieve optimum dental health by providing personalized and compassionate dental care. Their team is comprised of highly skilled professionals dedicated to excellence in every phase of dental treatment. They are committed to continued education, which enables delivery of the very finest, state-of-the-art cosmetic, restorative, and CEREC® same-day dentistry, along with Invisalign® clear aligners.

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