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(337) 704-2126 Schedule an Appointment 1601 Kaliste Saloom Rd, Lafayette LA 70508

Medical History

Although dental personnel primarily treat the area in and around your mouth, your mouth is an essential part of your entire body.  Health problems that you may have, or medication that you may be taking, could have an important interrelationship with the dentistry you will receive.

Please fill out the form below. If you have trouble filling out this form online, please email to send you a printable version of the form to fill out and bring with you to your next appointment.
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