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Park Cities Oral & Maxillofacial Surgery Associates

Address:
Dallas
6140 Sherry Lane
Dallas, TX 75225

Phone:
(214) 363-2475

Hours:
Mon–Thu: 9:00 AM–4:00 PM
Fri: 8:00 AM–12:00 PM

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03/05/2026Click to Sign
PATIENT INFORMATION
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Have there been any changes in your general health in the past year?
Are you under the care of a physician?
Have you had any illnesses, operations, or been hospitalized in the past five years?
Do you have unhealed/recurrent injuries or inflamed areas, growths, or sore spots in or around your mouth?
Do you have a prosthetic joint/implant?
Have you had a heart valve replacement or vascular graft?
Have you ever had general anesthesia?
Have you or a family member had any unusual or serious reactions to general anesthesia?
Has a physician or previous dentist recommended that you take antibiotics prior to your dental treatment?
Are you nursing?
Are you taking birth control pills?
Are you in good health?
Do you wish to speak to the doctor privately about anything?
Is this visit related to an accident?
If you are having surgery today, have you had anything to eat or drink in the past six hours?
Is there any condition concerning your health that the doctor should be told about?
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