Medical history form

Fill it in calmly at home instead of in the waiting room – that saves time and we know your history in advance.

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Well prepared for your first appointment

Here you will find our medical history forms for orthodontics, dental treatment of adults and paediatric dentistry. You can print the forms out and fill them in calmly at home before your visit to the practice.

Please also remember to bring your health insurance card as well as – if you have them – your bonus booklet, X-ray record and a list of your medications.

Our medical history forms as PDF

Choose the appropriate form. All you have to do is bring it with you, filled in, to your appointment.

Orthodontics – children

For the first orthodontic examination of children and adolescents.

Download PDF

Orthodontics – adults

For orthodontic treatment of adults.

Download PDF

Dental treatment – adults

For general dental treatment.

Download PDF

Paediatric dentistry

For your child's first visit to our paediatric dentistry department.

Download PDF

Frequently Asked Questions

Which form do I need?
For orthodontic treatment there is one form for children and one for adults, for general dental treatment an adult form, and for paediatric dentistry a separate form. If in doubt, simply bring the form that comes closest - we sort out the rest on site.
Do I have to print out the form?
No, it is an offer. You can also fill in the form at the practice. At home, however, you have more peace and quiet to enter medication and pre-existing conditions completely.
Why do you ask about pre-existing conditions and medication?
Some conditions and medicines influence dental treatment - for example blood thinners, bisphosphonates, heart conditions or allergies. This information matters for your safety.
What else do I need to bring to my first appointment?
Your health insurance card and, if you have them, your dental bonus booklet, X-ray record, implant passport and an up-to-date list of your medication.