
Please help us be prepared for your first appointment by completing one of our Medical History forms. Download a form from below (in PDF format) to your computer, print it out, complete the form, and FAX or mail it to our office prior to your first appointment.
Child Health History Form (PDF file)
Adult Health History Form (PDF file)
If you're unable to read PDF files, you can download Acrobat Reader free from Adobe.

2949 SW Wanamaker Dr. | Topeka, Kansas 66614-5325 Phone: (785) 272-6161 | Fax: (785) 272-4627 | Toll Free: 1-888-40 SMILE
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