Medical History

You can save time at your appointment by downloading the medical history form and filling it out before your scheduled visit.

Please make sure you have a complete list of all of your medical conditions and medications, including dosages as well as any recent tests like blood work, ECG, relevant and current dental X-rays.

Click the link below, to download our medical history form. It is setup to allow 2 sided printing if your printer supports this option.

http://drjefffield.com/wp/wp-content/uploads/2020/05/New-Medical-History-Revised-August-2018-2.pdf