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Dentist Federal Triangle | 955 L’Enfant Plaza SW Suite 1205, Washington DC, DC 20024, US | (202) 488-8300

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Dentist Federal Triangle

955 L’Enfant Plaza SW Suite 1205,
Washington, DC, DC 20024, US

(202) 488-8300

Monday: 7:30 am – 4:00 pm
Tuesday: 7:30 am – 4:00 pm
Wednesday: 7:30 am – 4:00 pm
Thursday: 7:30 am – 4:00 pm
Friday: Closed
Saturday: Closed
Sunday: Closed

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Dental News in Federal Triangle DC

Dentist Federal Triangle

October 1, 2023

Oral Cancer Risk Factors | Dentist in Federal Triangle

During a comprehensive dental examination, our team will look for signs of oral cancer. Early detection is key with oral cancer. If caught early, most forms of oral cancer are treatable. Our dental team is trained and educated to identify oral cancer. Everyone is susceptible to the disease, but some groups of people are at…
Read More >>
September 15, 2023

Dentistry – Past, Present, and Future | Federal Triangle Dentist

“Tooth worms” are the cause of tooth decay. That was the headline of a Sumerian text from around 5,000 B.C.E. Fortunately, the dental industry has evolved since then and we know “tooth worms” don’t exist. Here’s how dentistry has evolved into the comfortable, safe, and beneficial science of today. In the Beginning Did you know…
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September 1, 2023

Repair Your Smile with Dentures | Federal Triangle Dentist

Our dental team is pleased to provide high-quality removable dentures to new and existing patients who have experienced the loss of some or all of their teeth. These dentures are custom-crafted to fit the individual patient’s mouth and specific tooth replacement needs. They provide both a cosmetic and functional replacement solution for tooth loss. To…
Read More >>

© 2022 L’Enfant Plaza Dental Arts | Dentist Federal Triangle | 955 L’Enfant Plaza SW Suite 1205, Washington, DC, DC 20024, US | (202) 488-8300

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Medical History

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Have you ever had a serious head or neck injury?
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Are you taking any medications, pills, or drugs?
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Please list all medications and dosage

Are you on a special diet?
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Please tell us about your diet

Do you use tobacco?
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Please tell us how often and what type of tobacco consumption

Recreational drug and/or alcohol use, combined with local anesthesia may cause a life-threatening emergency.

Have you ever been advised that you require antibiotics prior to a dental appointment?
YesNo

Please tell us about the antibiotics

Do you take, or have you taken, PhenFen or Redux?
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Have you ever taken Fosomax, Boniva, Actonel or any other medications containing bisphosphonates?
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If so, please tell us about your bisphosphonate usage

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Have you recently consumed alcohol?
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Please tell how much alcohol and how recently

Women (Please check all that apply)
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Have you ever had an adverse reaction or allergies to any medication or substance? (Please check if allergic) *
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Do you have, or have you ever had any of the following medical conditions? (Please select all that apply) *
AnemiaChemotherapyColdSores/FeverBlistersCortisoneMedicationExcessiveBleedingFrequent CoughFrequent HeadachesHay FeverHemophiliaHigh Blood PressureHives or RashKidney ProblemsLiver DiseaseParathyroid DiseaseRecent Weight LossRheumatismShinglesSpina BifidaStrokeThyroid DiseaseVenereal DiseaseArthritis or GoutBlood DiseaseBruise EasilyCongenital Heart ProblemsDiabetesDrug/Alcohol AddictionEmphysemaFrequent UrinationHeart MurmurHeart Valve or PacemakerHerpesHypoglycemiaLung DiseaseRheumatic FeverTuberculosisUlcers or GI ProblemsAsthmaChest PainsConvulsionsEasily WindedExcessive ThirstFrequent DiarrheaGenital HerpesHeart Attack/Heart FailureHepatitis (B or C)Low Blood PressureIrregular HeartbeatLeukemiaMitral Valve ProlapseRadiation TreatmentsRenal DiseaseScarlet FeverSickle Cell DiseaseStomach/Intestinal DiseaseSwelling of LimbsTonsillitisYellow JaundiceArtificial JointBlood TransfusionCancerCurrently PregnantDizziness or FaintingEating DisorderEpilepsy or SeizuresGlaucomaHeart TroubleHepatitis (A)HIV-AIDS-ARCJaw Joint PainPsychiatric CareSinus ProblemsTumor or GrowthX-ray/ChemotherapyNo to All

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To the best of my knowledge, the questions on this form have been accurately answered. I understand that providing incorrect information can be dangerous to my (or patient’s) health. It is my responsibility to inform the dental office of any changes in medical status.

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Patient Information

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Relationship to Patient

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Address

City
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Phone Number

Alt. Phone Number

Employer

Employer Phone Number

Emergency Contact

Emergency Contact Name *

Relationship to Patient *

Address *

City *
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State / Province *

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Referral Information

Please share with us how you heard about our office. Thank you. *
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Signature *

Your health and safety always rank #1 with us.

You’ll notice a few differences when you visit, but the care you receive won’t be one of them. Here are a few things you’ll see:

We will use no-touch mobile communications such as text, email and phone.
Hand sanitizer is readily available.
We’re using some new protective gear.
If you’re not feeling well, we can help you reschedule.

There are also a few things behind the scenes that might not stand out. Just a few include:

Added cleaning and disinfection of public spaces.
Continued strict sterilization monitoring.
More training than required on protective measures

Did we mention that we’re excited to see you? But before we do, please take a minute to fill out the pre-appointment screening and health history forms by clicking below! Thank you.

COVID-19 Pre-Screen Questionnaire

First Name *

Last Name *

Contact Phone Number *

Email Address

Do you or have you had a fever of above 100 degrees in the past three days? *
NoYes

Have you recently lost or had a reduction in your senses of smell or taste? *
NoYes

Do you have a sore throat? *
NoYes

Do you have a dry cough? *
NoYes

Do you have a runny nose? *
NoYes

Have you been in contact with someone who has tested positive for or suspected they were positive for Covid-19 (corona virus?) in the last two weeks? *
NoYes

Have you tested positive for Covid-19 or are you awaiting test results for Covid-19 within the last 10 days? *
NoYes

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