Monday, 7:50 a.m. A new patient walks in holding the PDF from your website, printed at home and half filled in. Page two is blank. The front desk hands over a clipboard for the rest, then types the medication list into the chart while the 8:00 patient waits at the counter. At 8:10, in the chair, the dentist learns the patient takes a blood thinner.
Before anyone sits in your chair, the medical history form is their first task for your practice, and it's the page your dentists lean on most before anyone gets numbed. Below: what it should ask, section by section, how often to update it, what to say when a patient refuses, and how to get it signed on a phone the night before.
What the form is for
It does three jobs. It tells the dentist what changes the treatment: a blood thinner before an extraction, a heart condition that calls for antibiotics first, an allergy to latex or penicillin. It gives the hygienist the same picture before the cleaning. And it is your record that the question was asked, answered, signed and dated by the patient.
It costs the desk time when it arrives on paper. If your front desk retypes eight new-patient histories a week at ten minutes each, that's more than five hours a month at the counter.
Have your dentists and your malpractice carrier approve the final wording. The sections below are a starting point to take to them.
Patient details and emergency contact
Full name, preferred name, date of birth, address, mobile number and email. Ask which language the patient prefers for forms and texts. Then an emergency contact with a phone number, plus the name and phone of the patient's physician, so the dentist can call with a question about a medicine.
For a minor, add the parent or guardian, and who may sign for the child.
Medical conditions: the yes-or-no list
A checklist reads fastest, for the patient filling it in and for the dentist scanning it. Group it by body system and keep each line plain:
- Heart: heart attack, murmur, artificial valve, past heart infection, pacemaker
- Circulation: high or low blood pressure, stroke
- Blood: bleeding problems, anemia, past transfusions
- Lungs: asthma, COPD, tuberculosis, sleep apnea
- Hormones: diabetes, thyroid disease
- Infections: hepatitis, HIV
- Bones and joints: artificial hip or knee, osteoporosis
- Cancer: past or current, chemotherapy, radiation to the head or neck
- Kidneys and liver: disease, dialysis, transplant
- Nerves and mood: seizures, fainting, anxiety, depression
Give every line a yes box and a no box. A single “check all that apply” list leaves the dentist guessing whether a blank means no or skipped.
Finish the list with “Anything else we should know?” and an open box. Patients write things there that no checklist asked about.
Medications, including the ones patients forget
Ask for every medicine with its dose. Then ask again for the three groups patients leave off: pills from the drugstore shelf, such as a daily aspirin; vitamins and supplements; and shots given every few months or once a year.
Name the medicines that matter most in a dental chair, so patients recognize them: blood thinners such as warfarin, apixaban and clopidogrel; bone drugs such as alendronate and denosumab; weekly diabetes and weight-loss shots such as semaglutide and tirzepatide; and anything that dries the mouth. One more line catches the rest: “Include eye drops, inhalers and patches.”
Allergies and past reactions
Give a yes-or-no line for each of the usual ones: numbing medicine, penicillin and other antibiotics, codeine and other pain medicines, latex, and metals such as nickel. Then ask what happened.
The answer matters. A patient who writes “allergic to Novocaine” often means a racing heart after a numbing shot, which is a different problem with a different fix. One open box under the allergy list lets the dentist tell the two apart before the appointment instead of during it.
Dental history and why they're here
What brings them in, in their own words. The date of their last cleaning. Any pain, sensitivity or bleeding gums right now. Past trouble at the dentist: numbing that didn't take, fainting, a visit that went badly. Grinding or clenching, earlier braces or aligners, gum treatment.
Add one question many forms skip: “How do you feel about dental visits?” A patient who answers “very nervous” is worth a heads-up to the hygienist before seating.
Habits, pregnancy and the signature
Tobacco and vaping, with how much and how often. Pregnancy or nursing, with a due date. Then the signature block: the patient confirms the answers are true to the best of their knowledge and agrees to tell the office about any change. Date it. On paper, the dentist initials beside the signature after reading it; keep that step on the online version too.
How often patients should update it
Ask about changes at every visit, and have patients sign a full update once a year. Most patients see the hygienist two to four times a year, so the visits in between need a short version. Five questions cover it:
- Any new medicines, or any you've stopped, since your last visit?
- Any surgery, hospital stay or new diagnosis?
- Any new allergies?
- Are you pregnant or nursing?
- Has your physician changed?
That takes a patient under a minute. Any yes, and they fill in that section of the full form again.
When a patient won't fill it in
“I'm not filling that out” usually means one of four things. They did it last year, they're uneasy about privacy, they're short on time, or the small print is hard to read. A line for each:
- Did it already: “Thanks for doing it last time. This one's five questions about what's changed.”
- Privacy: “It stays in your record with us. The dentist reads it to choose which numbing medicine is safe for you.”
- Short on time: “I'll send the form to your phone, so you can finish it before we call you in.”
- Hard to read: “Let's go through it together over here,” at a seat away from the counter.
If the answer is still no, the dentist decides whether to go ahead, and the desk notes the refusal in the patient's file.
Spanish and other languages
About one in eight people in the US, more than 40 million, speak Spanish at home, and in some neighborhoods that's most of your new patients. A Spanish history needs a translation done by a person and read by a Spanish speaker on your team. Keep the questions in the same order as the English version, so the dentist finds each answer in the same spot. FlossBooked sends each patient the form in the language on their record.
Getting it filled in before the visit
A printed PDF asks a lot of a patient: download, print, write by hand, remember to bring it. A text asks for one tap. With FlossBooked, the forms for each visit type go out by text when the visit is booked, and the patient fills them in on a phone and signs with a finger. Most finish the same evening.
Send the link at booking, send it again with the visit reminder, and keep a tablet at the desk for anyone who still arrives without it. Procedure consent forms can go out the same way. At setup, our team rebuilds the paper forms you use today as online ones, in your wording.
What happens to the answers
Once signed, the history sits on the patient's record as a PDF. Through the two-way connection with your practice software, it's filed to the same patient there, so nobody retypes a medication list at 7:50. The dentist can read the history on a phone before walking into the room. Every plan includes HIPAA-compliant forms, portal and messages, with a signed BAA.
See how sending, signing and tablet check-in work on Medical History & Check-in. Every plan carries the whole thing, starting at $97 a month. Compare the plans.
FlossBooked
FlossBooked brings US dental practices their patient forms, phones, website and new-patient marketing, with our team doing the setup. We rebuild every practice's paper forms during setup, and this post comes from that work.
