6. ORTHODONTIC HISTORY
What are the main concerns that you would like orthodontics to accomplish?
For each question, include a field for 1-5.
Please rate the following aspects of orthodontic treatment using the scale of importance below:
(1) Not important (2) Somewhat important (3) Important
(4) Very important (5) Extremely important
Please Describe your chil's current physical health:
Please list all drugs that your child is currently taking:
Please list all drugs that your child is allergic to:
7. Has your child ever had any of the following medical problems?
Please discuss any medical problems that your child has had:
8. Does/did your child have any of the following habits?