Mr/Mrs/Ms/DrLastFirstMI - North Sioux Dental Clinic

Have you ever had gum disease?Yes / No. Do you have any loose teeth?Yes / No. Are your teeth sensitive to chewing, hot, cold, or . sweet foods? Yes / No. Do you have your wisdom teeth?Yes / No. If you are new to the office: Previous Dentist: _____ Last visit: _____ Why did you leave your . previous dentist? _____ What did you like most/least ... ................
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