The Next Dr. Moses!
UB Dental Graduation 2021
Thank you to all who supported Tim through this incredible journey. It has meant the world to Tim, and to us.
-Dr. Moses' Office
Thank you to all who supported Tim through this incredible journey. It has meant the world to Tim, and to us.
-Dr. Moses' Office
Pre-Treatment Forms
COVID-19 Pre-Treatment Questionnaire
- The safety of patients and staff is the highest priority of Dr. Moses' office. Patients are required to fill out and sign the following form before every visit. Thank you for your cooperation
Health Questionnaire
This is a pre-treatment medical evaluation to be filled out by a patient's physician.
physicians_medical_evaluation.pdf | |
File Size: | 44 kb |
File Type: |
physicians_medical_evaluation.doc | |
File Size: | 26 kb |
File Type: | doc |
Medical History Form
This form is required prior to treatment, and gives us information on your medical background. At every dental visit hereafter, an update is made to the patient's medical history.
medical_history_form.pdf | |
File Size: | 51 kb |
File Type: |
medical_history_form_word.doc | |
File Size: | 14 kb |
File Type: | doc |
Acquaintance Form
This form is requested before treatment, and gives us a better idea of your situation and dental history.
acquaintance_form.pdf | |
File Size: | 37 kb |
File Type: |
acquaintance_form_word.doc | |
File Size: | 9 kb |
File Type: | doc |
Dental Records Release
Dental records include radiographs (x-rays) and information about your treatment. This requires written authorization. Please contact our office for more information.
Dental records include radiographs (x-rays) and information about your treatment. This requires written authorization. Please contact our office for more information.