Quickly obtain dental & medical history information with easy-to-use form.

• Please note: No hole punch.
• Double-sided form. Printed on both sides on white ledger stock.
• Checklist format. Forms are designed to prompt responses through a simple checklist format; dentist can quickly scan the completed form & identify problem areas to discuss with the patient.
• Size: 7 3/4 x 10" scored to easily fold to 5 x 8" card format.