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Louise Garren
Cleaning & exam · Dillard, GA
On paperEntered from paper 21 hr ago · MetLife PPO · 3 of 3 pages
Worth a glance before the visit
Latex allergy
This one arrived on the printed 2016 form and was re-typed by the front desk, one field at a time. Every field below is exactly the retyping the phone form removes.
Dental registration
Complete- Full name
- Louise Garren
- Date of birth
- November 15, 1949 · age 76
- Sex
- Female
- Marital status
- Widowed
- Address
- 88 Betty's Creek Rd, Dillard, GA 30537
- lgarren@example.com
- Cell phone
- 706-555-0117 · best time Mornings
- Home phone
- 706-555-0116
- Employer or school
- Retired · Retired teacher
- Emergency contact
- Danny Garren (Son) · 706-555-0118
- How they found us
- Family
- Social security
- Last four on file from the paper form.
Medical history
Complete- Under a physician's care
- Yes · Primary care, for arthritis
- Recent hospitalization
- No
- Head or neck injury
- No
- Current medications
- Levothyroxine
- Special diet
- No
- Uses tobacco
- No
- In pain right now
- No
- General health
- Good
- Allergies
- Latex
- Conditions
- ArthritisHypothyroidism
Dental history
Complete- Reason for visit
- Regular cleaning and check-up
- Former dentist
- Patterson Family Smiles
- Last visit
- About 7 months ago
- Last x-rays
- About a year ago
- Dental anxiety
- 1 of 10
- Past experience
- Excellent
- Symptoms
- Bleeding gums
- Clench or grind
- No
- Jaw or TMJ soreness
- No
- Missing teeth
- Yes
- Teeth hurting now
- No
- Bisphosphonate medication
- No