Patient Resources

Health History Form

At Claremont Smile Design, we prioritize your well-being in every aspect of your dental care. Keeping us informed about your medical history is a vital step in ensuring that your treatment is safe, effective, and tailored to your unique needs. We understand that your health can change over time, so we provide a Health History Form to help us stay up-to-date with your medical information.


Basic Information

Have there been any changes to your dental insurance?


Are you taking any new medications?
If yes, please list below:


Patient/guardian signature indicates the above information is complete and accurate:

Dental Offices in Claremont

To schedule your appointment

Use the form beside to provide us with the information, and our coordinator will contact you for convenient appointment times.

Office Hours

(Please call our office for details and to schedule your appointment.)