Dental Medical History Form, Canva Template: New Patient Intake and Health Questionnaire for Dentists, Word and PDF
NowPrice:$4.80
Original Price: $6.00
20% off
Sale ends on November 15
Here's what's eligible:
- Your order doesn't match the item description or photos
- Your item arrived damaged
- Your item arrived after the estimated arrival window
- Your item didn't arrive or was lost in the mail
You can only make an offer when buying a single item
Highlights
A clean two-page medical and dental history form for new patients, with a box for clinic use. Brand it, edit it and print it.
NEW: EDIT IT IN CANVA TOO
The form also comes as a ready Canva template with editable text, colours and shapes, in English and Turkish. Open the links PDF in your download, press Use template and edit in your own Canva account. A free Canva account is enough.
WHAT IS INSIDE
- About you, with an emergency contact
- Medical history with yes or no answers
- Allergies and the medication they take
- Teeth and mouth, dental anxiety and smile goals
- Declaration, signature and a box for clinic use
EDIT IT YOUR WAY
- Kit-Builder.html: logo, colour and contacts once, then click any text to edit. Works offline in Chrome or Edge.
- Canva: both pages as a ready Canva template, in English and Turkish.
- Word file, fully editable.
- 3 ready styles. English and Turkish included.
FILES YOU GET (one zip and one PDF)
- Kit-Builder.html
- Canva template links PDF: 2 Canva designs, 1 in English and 1 in Turkish, with both pages of the form
- 2 A4 pages as PDF in English and Turkish
- Word files in English and Turkish
- Quick start guide
Want the whole patient journey, from the welcome guide to the aftercare? See the full Clinic Patient Kit in our shop.
GOOD TO KNOW
- Digital download. Nothing is shipped.
- The builder runs on a computer in Chrome or Edge. No account, no subscription, no internet needed.
- This questionnaire is a professional template, not legal or medical advice. Have it reviewed by your dentists and adjusted to the data protection rules in your country.
- One licence covers one clinic brand with all its locations. Please do not resell or share the files.
- Questions? Send us a message on Etsy.
How it was made: designed and written by Silit Labs, based on hands-on experience in dental tourism, with help from AI tools for drafting and layout. Every document was reviewed and edited by us.
Instant Download
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