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Wappinger Falls Poughkeepsie Fishkill Hopewell Junction Lagrange White Plains Hudson Newburgh Kingston
Dr. Leon D James DDS, MBA
The Journey to a New Smile Begins
Hudson Valley TMD & Facial Aesthetics
2789 West Main St
Wappingers Fallas, NY 12590
For more information, please send a email to firstname.lastname@example.org
Medical History Information
Have you ever had any serious illness is not listed above?
Let’s all medications and supplements you were taking?
To the best of my knowledge, the questions on this form has been accurately answered. I understand that they provide an incorrect information can be dangerous to my or patient’s health. It is my responsibility to inform the dental office of any changes in medical status.
Signature of patients or guardian
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