Medical History Update

Has anything changed since your last visit? Please update your medical history so we can continue to provide you with the safest care.

Patient Information

First Name *

Last Name *

Date of Birth *

Phone Number *

Medical Conditions

New conditions diagnosed since your last visit

Conditions that no longer apply

Medications

Have your medications changed since your last visit?

Current medications (including dosage)

Allergies

Have your allergies changed since your last visit?

Current known allergies

Lifestyle & Other Changes

Are you pregnant or nursing?

Smoking / tobacco use

Any surgery or hospitalisation in the past year?

Additional Notes

Anything else you'd like us to know?

SMS Notifications

Mobile Number for SMS

Enter a Canadian mobile number if you'd like to receive SMS reminders from our office.

I consent to receive SMS text messages from Ocean Dental Care at the mobile number provided above. Messages may include appointment reminders, confirmations, and office updates. Message and data rates may apply. Reply STOP at any time to opt out.

Signature

By signing below, you confirm that the information provided is accurate and complete to the best of your knowledge.

Patient Signature *

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Date: July 31, 2026

I consent to Ocean Dental Care updating and using my personal and medical information for the purpose of providing dental care, as described in the Privacy Policy. I understand I may withdraw consent at any time by contacting the office.

Your information is kept strictly confidential and used only to provide your dental care.

Contact Us

905-825-2344

Mon – Fri: 9:00 AM – 6:00 PM

204-1131 Nottinghill Gate
Oakville, ON L6M 1K5

Why Keep Us Updated?

Changes in your health, medications, or allergies can directly affect your dental treatment. Keeping your records current helps us provide the safest care possible.