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Dr. Amardeep Gill
Dr. Arman Sonuhi
Dr. Kirpaul Chattha
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Do you have any serious Medical Conditions we should know about?
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Please explain.
Known Medical Conditions
Alcohol/ Drug Abuse
Angina
Arthritis
Asthma
Blood Disorder
Cancer
Chemotherapy
Congenital Heart Defect
Diabetes
Dizziness/Fainting
Emphysema
Epilepsy/Seizures
Frequent Headaches
Gag Reflex
Hay Fever
Head Injuries
Hearing Disabled
Heart Attack
Heart Murmur
Hemophilia
No Known Medical Issues
Please select each Medical Condition that is applicable for you!
Known Medical Conditions cont'd
Hepatitis A/B/C
High Blood Pressure
HIV/AIDS
Joint Replacement (hip, knee, etc)
Kidney Disease
Liver Disease
Low Blood Pressure
Lung Disease/ Tuberculosis
Mental Disorder
Mitral Valve Prolapse
Multiple Sclerosis
Pacemaker
Radiation Therapy
Respiratory Problems
Sinus Problem
STD
Stomach/Intestinal Problems
Stroke
Thyroid Disorder
Ulcer
Other
If Other selected, please specify:
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Do you have any allergies to medication or substances?
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What Allergies do you have?
Are you taking any prescription medication or herbal remedies? (including cannabis)
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Please list off your medications
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Do you need to be medicated with antibiotics prior to dental treatment
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Do you smoke or use chewing tobacco?
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Have you ever been treated for any other illness not listed above?
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If Yes selected, please specify:
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Are you pregnant and/or nursing?
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How far along is your pregnancy?
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Have you recently been under the care of a physician?
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About Us
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Dr. Amardeep Gill
Dr. Arman Sonuhi
Dr. Kirpaul Chattha
Our Services
Toggle child menu
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Cosmetic Dentistry
Toggle child menu
Expand
Restorations
Toggle child menu
Expand
Gum & Bone Grafting
Periodontics
Dental Exams & Cleanings
Toggle child menu
Expand
Oral Cancer Exam
Pediatric Dentistry
Cleanings Prevention
Dental Anxiety And Fear
Dental X-Rays
Tooth Extractions
Toggle child menu
Expand
Wisdom Tooth Extraction
Dental Emergencies
Root Canal Therapy
Invisalign
Office Forms
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Expand
New Patient Form
Covid-19 Consent Form
X-Ray Release Form
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