Medical History Form

92 Tapleys Hill Road, Royal Park SA 5014

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Medical History Form

Why is it Important to fill in a Medical History Form for Your Dentist?

A patients’ medical history enables the dentist to obtain information necessary to provide safe and individualised care. It is for your own safety and as part of the Australian Dental Regulations that a thorough medical history is taken. A medical history helps to identify conditions relevant to your dental health or which could have an impact on how treatment is carried out.

You must tick (Yes or No) for each of the conditions listed on the form. You must note any and all allergies, other conditions not mentioned and ALL medications.

Information about certain medical conditions such as diabetes, epilepsy, allergies or heart disease could be vital if a medical emergency occurs in the dental practice. Patients’ quite often do not realise that a straight forward clean can have serious medical implications if they have not informed their dentist of specific medical conditions. Patients with heart conditions and/or stents, joint replacements or other conditions requiring careful monitoring may require a prophylactic course of antibiotics prior to dental treatment to be safe.

Even a thyroid condition may hinder the body’s ability to heal wounds and this is then related to extractions or oral surgery you may need now or in the future. Allergies to medications, uncontrolled high or low blood pressure may cause serious consequences if the dentist is not informed or these conditions.

Dentistry is holistic, we help you maintain a healthy well-being and treat you as a person instead of a mouth full of teeth.

Under the Australian Dental Association, we are required to have an updated medical history every 12 months, this means we print out the medical history you filled out last time and ask you to check over it and make any changes and resign it.

Please be assured that all information is kept strictly confidential and is not used outside the dental office without your permission.

If you have any questions please don’t hesitate to call and speak to our friendly staff.

Common Medications the Dentist Needs to Know You are Taking

Of particular importance to the medical history is a list of any medications a patient is currently taking. These may include drugs prescribed by a doctor or specialist as well as those purchased over the counter. Many medications when combined can interact and reduce the efficacy of other medications which may be prescribed by your dentist. They may also indicate an underlying condition not previously noted.

Please note that your dentist may not be able to proceed with a dental treatment if he/she does not have your relevant medical history. You may be required to come back for the next appointment when the medical history form is fully completed. Your health and safety is paramount to us.

Here is a list of common medications the dentist needs to know you are taking:  

Actonel Apixaban Seretide Aspirin
Aclasta Aspirin Symbicort Calcium
Alendronate Astrix   Iron
Altevia Cartia



APD Clavix Decadron St John’s Wart
Aredia Clopidogrel Dexasone All Fish Oils
Binosto Coumadin Solurex Garlic tabs
Bonefos Equilis Zema Pak  
Boniva Heparin    
Didronel Marevan    
Fosamax Plavix    
Loron Pradaxa    
Nerixia Xarelto    
Reclast Warfarin    

Medications small

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