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Health History Questionnaire - Two Sided #4054

These proven forms capture patient health history quickly & comprehensively! Questionnaire covers both dental & medical information.

  • Please note: No-hole punch.
  • Easy to read. Dentist can quickly scan the completed form & identify problem "yes" areas to discuss with the patient.
  • Simple checklist format. Forms use a series of questions designed to prompt responses through a simple checklist format.
  • Double-sided. Printed on 2 sides on white ledger stock.
  • Size: 8 1/2 x 11"

Health History Questionnaire - Two Sided #4054

  • $71.40
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