Philip K. Kock, D.M.D., P.C.
Oral Surgery
1221 Sherwood Park Dr., Suite B, Gainesville, GA 30501
770-534-1492
  • Patient Information
    • Introduction
    • Directions
    • First Visit
    • Scheduling
    • Financial Policy
    • Insurance
    • Privacy Policy
    • Online Videos
  • Meet Us
    • Meet Dr. Koch
    • Meet the Staff
  • Procedures
    • Dental Implants
    • Cost of Dental Implants
    • Bone Grafting
    • Wisdom Teeth
    • Impacted Canines
    • Facial Trauma
    • Jaw Surgery
    • Oral Pathology
    • Platelet Rich Plasma
  • Surgical Instructions
    • Before Anesthesia
    • After Dental Implant Surgery
    • After Wisdom Tooth Removal
    • After Exposure of an Impacted Tooth
    • After Extractions
    • After Multiple Extractions
  • Online Forms
    • History Sheet
  • Referring Doctors
    • Referral Form
    • Links of Interest
  • Contact Us
    • Contact Our Office
    • Map

History Sheet

Please download and fill-out our History Sheet Form. After you have completed the form, please make sure to bring it on your first visit to our office. The security and privacy of your personal data is one of our primary concerns and we have taken every precaution to protect it.

  • Download Our History Sheet Form

Technical Note:

PC Users
Our online form uses the latest version of Adobe Acrobat Reader to conveniently submit the form from home or work. Please download the free plug-in from Adobe’s web site if it is not already installed on your system. It is important that you have at least version 9 of the plug-in to successfully use our online form.

Mac Users
You must open and submit the form in a Safari Browser with the latest Mac operating system. It is also important to have the latest version of Adobe Acrobat Reader on your computer in order to submit your form to our office correctly, please download the free plug-in from Adobe’s web site.

 

 

Philip E. Koch, D.M.D., P.C.

Address: 1221 Sherwood Park Dr., Ste. B • Gainesville, GA 30501
Phone: 770-534-1492 • Fax: 770-534-8309

 

 

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