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Medical History: Online Forms

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CLICK HERE to enter: CHILD Medical History

 

CLICK HERE to enter: ADULT Medical History

Please note:  When entering your medical history and patient information, there is a default 10 minute timeout after lack of activity.  If a timeout occurs, you will have to restart from the beginning.  We apologize for any inconvenience this may cause.

Super Smiles * 300 N. Aspen * Broken Arrow * OK * 74012
Phone:  918-251-3333
   
   Fax:  918-251-3339