Health Checklist

Health Checklist

If you would like to become a patient at M3 Mondzorg and you are 18 years or older, we will also need a completed health questionnaire from you. Thank you in advance!

Why is a health checklist important for your dentist and dental hygienst?

Complaints in the mouth can be caused by illness or medication use. If you are ill or taking medication, this may limit dental treatment or require you to take precautions. It is important that your dentist takes this into account. Always inform your dentist if anything has changed in your health or your medication use. Your data is covered by medical confidentiality and will therefore be treated confidentially. We kindly ask you to take a recent medication overview with you every time you visit your dentist. You can ask your pharmacist for a recent overview.
We use your data for registration in our patient database and to communicate with you (more information about the use of your data can be found in our privacy statement).

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    Please fill out name, address, telephone number and e-mail administrator:

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    Bring a recent medication overview to every dental visit. You can request a recent overview from your pharmacist.

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