Mark L Davies, DDS, FAGD
1664 Village Green • Crofton, MD 21114 • (301) 261-3800 • (410) 721-8688
www.drmarkdavies.com

Dental History Form

If yes, please check the following that apply:
What are your short, medium, and long term goals for your mouth and teeth?
Examples are: needles, noise, smell, invasion of personal space.
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