Describe the nature of your child’s disability:
Please list all medications both prescription and over-the-counter that the patient is taking.
Has your child ever had seizures?
If so, when was the last one?
Describe the type of seizure.
Does your child have any allergies?
Does your child breathe through their nose or mouth?
Does your child snore?
Does your child wear a hearing aid?
Does your child have any other physical challenges the dental team should be aware of?
Is your child on a special diet? (Gluten free, casein free)