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                                                        DR. DAN PETERSON

                                                                      1415 SAGE STREET ~ GERING, NEBRASKA 69341 
      Call: 308-436-3491           

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     This medical history is important because when combined with the results of your initial clinical examination, we will than be able to access your immediate dental care needs and recommend the best treatment approach. 

    Be sure to mention everything about your health, even if you don't think it relates to your mouth.  If you have had surgery or a major illness, be sure to include this information in this medical history.  Many disease can have significant effects on your mouth and teeth, and research continues to discover ways in which oral health is related to overall health.  Diabetes, for instance, can increase the risk of gum disease.

    Information about medications you are currently taking can be vital to your health, especially in an emergency.  Some medications cause dry mouth, which can increase the risk of cavities or affect the type of anesthesia to be given.    When you come to your appointment be sure to bring a current list of medications you are taking to insure an accurate record.  

     We assure you that all the information you provide us with will remain confidential.

As a patient you have the choice too:


Fill the medical/dental history form out send it to us by fax 308-436-3451.


Download the medical/dental history form, fill it out at home and bring it with you for your appointment or mail it to us one week before your appointment to 1415 Sage Street, Gering, NE 69341.


Or wait until your first appointment and fill this information out at our office.  

     If you choose to submit this completed form beforehand it will assure faster processing of your paperwork at your appointment. So when you arrive for this appointment all you will have to do is sign and date this form to validate that it is accurate and up to date. 

Fill out the medical history form in the convenience of your home.

Click here to fill out:  Medical/Dental History Form 

(Warning: there is no encryption system protecting the confidentiality of any material  that you may sent to us)

AGD Impact p19 2.04

Medical History in different languages.

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          If you have any questions please e-mail me at:
                                                                                 308-436-3491 Office number

PLEASE NOTE: The information contained herein is intended for educational purposes only.  It is not intended and should not be construed as the delivery of dental/medical care and is not a substitute for personal hands on dental/medical attention, diagnosis or treatment.  Persons requiring diagnosis, treatment, or with specific questions are urged to contact your family dental/health care provider for appropriate care.
This site is privately and personally sponsored, funded and supported by Dr. Peterson.  We have no outside funding.
Confidentiality of data including your identity, is respected  by this Web site. We undertake to honor or exceed the legal requirements of medical/health information privacy that apply in Nebraska.

Copyright 1998-2008 Family Gentle Dental Care, all rights reserved.