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London Square Dental Centre

Patient Medical & Dental Health History

Accurate health information is essential for safe, effective dental care tailored to your needs.

Your medical and dental health history is one of the most important forms we collect. This information allows our dental team to provide safe, personalized care and avoid potential complications. All information is kept strictly confidential in accordance with Alberta privacy laws.

What the Form Covers

  • General health status and any ongoing conditions
  • Heart and cardiovascular health history
  • Respiratory conditions (asthma, sleep apnea, etc.)
  • Diabetes and endocrine conditions
  • Allergies to medications, latex, or dental materials
  • Current medications and supplements
  • Previous surgeries and hospitalizations
  • Pregnancy or nursing status
  • Dental history including past treatments and concerns
  • Jaw pain, clicking, or TMJ issues
  • History of bleeding disorders or blood thinners
  • Tobacco, alcohol, and substance use history

Why This Information Matters

Medication Interactions

Certain medications can affect dental treatment, anaesthesia, and healing. Knowing your full medication list helps us avoid dangerous interactions.

Allergy Prevention

Allergies to latex, antibiotics, or dental materials require alternative approaches. Full allergy disclosure keeps you safe.

Treatment Planning

Conditions like diabetes, heart disease, or blood disorders require modified treatment protocols for your safety.

Anaesthesia Safety

Your medical history helps us choose the safest sedation and anaesthesia options for your procedures.

Keeping Your Information Current

Please inform us of any changes to your health, medications, or allergies at each visit. Even seemingly minor changes can affect your dental care. Our team will review your health history periodically to ensure it stays up to date.

You can complete the medical and dental health history form at our office before your appointment, or contact us at (403) 291-4945 if you have questions about any section.

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