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Dental History Form - Motorola Solutions Mobile App

A complete medical data tracking form that is simple for any user to fill out. Proven effective for any medical office, this app allows customization for all types of medical history. This application allows the patient to enter all relevant information which includes previous injuries, previous operations, previous medications and even previous doctors. There is also additional space for each patient to enter in multiple lines of other relevant information that the doctor can use to make a more precise diagnosis. From questions posed about levels of comfort down to the specifics of the last check-up date, this application includes all the up front screening and history. This app can be easily customized, and works on a variety of Motorola Solutions devices, including the ES400 and ET1.

  • Lendlease
  • The Cooperative
  • PG&E
  • Red Bull
  • Mirvac

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Take a peek inside the Dental History Form - Motorola Solutions Mobile App

Included Features

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Included Fields

Customize to add, remove, or edit any of the fields below.

  • Ico dropdown

    What is the reason for seeking dental treatment at this time?

  • Ico multiline

    Please explain:

  • Ico date

    When was your last examination?

  • Ico textbox

    Name of your previous dentist?

  • Ico textbox

    City

  • Ico dropdown

    Does dental treatment make you nervous?

  • Ico statictext

    Please answer Yes or No, if Yes please explain:

  • Ico checkbox

    Have you ever had any serious trouble associated with previous dental treatment?

  • Ico textbox

    If Yes - Explain:

  • Ico checkbox

    Do you have a difficult time becoming numb with dental anesthetic?

  • Ico textbox

    If Yes, Explain:

  • Ico checkbox

    Have you ever had a lesion in your mouth that would not heal or was slow to heal?

  • Ico textbox

    If Yes, Explain:

  • Ico checkbox

    Have you had any injuries to your face or jaws?

  • Ico textbox

    If Yes, Explain:

  • Ico statictext

    Have you ever had any of the following significant dental treatments:

  • Ico checkbox

    Periodontics?

  • Ico textbox

    If Yes, Explain:

  • Ico checkbox

    Orthodontics?

  • Ico textbox

    If Yes, Explain:

  • Ico checkbox

    Oral surgery?

  • Ico textbox

    If Yes, Explain:

  • Ico checkbox

    Endodontics?

  • Ico textbox

    If Yes, Explain:

  • Ico checkbox

    Removable Prosthetics?

  • Ico textbox

    If Yes, Explain:

  • Ico checkbox

    Do you frequently consume sugar such as gum, soda pop, life savers, or candy bars, etc.

  • Ico checkbox

    Are you a heavy coffee or tea drinker?

  • ...and More!

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