BOCA RATON STUDENT HEALTH SERVICES

Dental Clinic Health History Form

You have two options:

• Print a blank form and then complete the form by hand.

OR

• Complete the form as it appears on the screen, by filling in all appropriate information. After completing the form, press the ENTER/RETURN key and then print.

Bring the completed form to your dental appointment.

Please note: NO information is being collected electronically utilizing this form. You will still need to print the form and submit it to Student Health Services.