Chris Haganman, DDS, Brad Stovie, DDS, Shannon Hingst, DDS, 815 38th Stree SE, Cedar Rapids, IA 52403
New Patient Forms

formIf you would like to complete your registration forms before you arrive, you may download them by clicking below. The new patient forms are in PDF format. If you do not have Acrobat Reader, get a free copy by clicking on the link below.

 



Adobe PDFAdobe ReaderOffice Policies (Acrobat PDF form)

Adobe PDFAdult New Patient Information (Acrobat PDF form)

Adobe PDF Youth New Patient Information (Acrobat PDF form)

Adobe PDFMedical History (Acrobat PDF form)

 

Why would we need to know about your general health?

Good question

People have general health conditions that affect dentistry, believe it or not. Changes in medical conditions may affect how we treat you, even for a "cleaning". We look after your entire health, as the systemic links between oral health and general health are founded now in research. That's why was have you fill out Medical History forms.

Medical Conditions/Diseases

Some heart conditions indicate prior premedication (antibiotic) needs (yes even for a cleaning), so as not to increase your risk of Bacterial Endocartitis (heart infection). Artificial joints also indicate the need for premedication. In addition heart disease, cancer treatment and some surgeries may dictate our care for you.

Medications

Prescription medication is important for us to know, as we may need to prescribe medicines and understanding how these may interrelate is crucial. Often times a side affect of medications is dry mouth. A drier mouth increases the rate of decay and periodontal (gum) disease. Over the counter vitamins, supplements and analgesics are important for us to know; again as they may interrelate to oral conditions or medicines we need to prescribe.

Blood Pressure

We are routinely taking your blood pressure as an indicator for general health and as a courtesy to you. An abnormal blood pressure reading may alter our treatment as it relates to the type of anesthesia we use as well as links to periodontal disease.

Categories for Blood Pressure Levels in Adults*
(In mmHg, millimeters of mercury)

Category

Systolic
(Top number)

Diastolic
(Bottom number)
Normal
Less than 120
Less than 80
Prehypertension
120-139
80-89
High Blood Pressure
Systolic
Diastolic
Stage 1 (Slight - Moderate)
140-159
90-99
Stage 2 (Severe)
160 or higher
100 or higher

*For adults 18 and older who:

Are not on medicine for high blood pressure, not having short-term serious illness, and do not have other conditions such as diabetes and kidney disease.


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