Instructions for Basic Forms


We know that your time is valuable. To ensure that your visit is as productive as possible, we recommend that you do the following:

  • Fill out all of the forms completely. Though some of the health history questionnaires may seem redundant, the information is essential for our providing you with the best care possible. We especially want to know about your previous caregivers and what specific complaints have brought you to our office.
  • Bring notes regarding your symptoms and concerns. Describe them briefly but thoroughly. Estimate how long you have had them. Grade each on a scale of 1 to 10, 1 being mild and 10 being severe.
  • When here, share what else is going on in your life (e.g., divorce, death of loved one, job change) and how you feel about it. This will allow us to get the most complete sense of your current health situation, how it is affecting you – and what is being affected by it.

In preparation for your visit, you also may find it useful to spend some time writing about the events in your life as they relate to your health or creating a timeline of your health issues and major life events. This can help you crystallize your sense of what;s going on with respect to your health (thus making it easier to recall and discuss during your visit) and perhaps even see relationships and patterns among the events that weren’t apparent to you before. If you do this writing, please bring it with you or include it with any paperwork or records you will be sending us in advance.

Other things you can do:

At your visit

  • Listen carefully and take notes.
  • Ask questions until you understand what you need to know.
  • Ask about all available treatment options, what Dr. Verigin recommends and why.

After your visit

  • Learn as much as necessary about your current health condition, consulting other sources of information as needed.
  • Consider the possible consequences of the proposed treatment options.
  • Get a second or third opinion, if appropriate.
  • Choose the treatment you believe will work best for you.
  • Decide on the best source to provide this treatment.

Please proceed through the forms under “Basic Forms – General Dentistry.” When you finish a form, it will automatically direct you to the next form.