Welcome to our practice! All of us at Nadeau Orthodontics, P.A. thank you for choosing us for your
orthodontic needs. We pride ourselves in ensuring our patient’s and their families receive both
outstanding orthodontic treatment and exemplary customer service. In order for us to fulfill our
promise please take a few minutes to complete our patient registration form, medical health history
form, and dental health history form. Thank you!
ADULT MEDICAL HEALTH HISTORY
*Your responses to the following questions are for our office records only and will be considered confidential.*
PLEASE CIRCLE ALL CONDITIONS THAT APPLY TO YOU.
ADULT DENTAL HEALTH HISTORY
PLEASE CHECK THE LINE IF THE CONDITION(S) APPLIES TO YOU.
I HAVE READ AND UNDERSTAND THE ABOVE QUESTIONS. I WILL NOT HOLD DR. NADEAU OR ANY MEMBER OF HIS STAFF RESPONSIBLE FOR ANY ERRORS OR
OMISSIONS THAT I HAVE MADE IN THE COMPLETION OF THIS FORM. IF THERE ARE ANY CHANGES LATER TO THIS HISTORY RECORD OR MEDICAL / DENTAL STATUS I
WILL INFORM THIS PRACTICE.