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 patients 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, medical health history, and dental health history form. Thank you!
CHILD 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 YOUR CHILD.
CHILD DENTAL HEALTH HISTORY
PLEASE CHECK THE LINE IF THE CONDITION(S) APPLIES TO YOUR CHILD
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.