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Alexandria Oral Surgery & Dental Implant Center

Address:
Alexandria
1403 Peterman Drive
Alexandria, LA 71301

Other Locations
Vidalia

Phone:
(318) 443-7208

Hours:
Mon–Thu: 7:30 AM–4:30 PM
Fri: 6:30 AM–3:00 PM

Contact Us

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Marital Status
Sex
salutation
Responsible Party
Marital Status 2
Antibiotics
Digitals Inderal Nitroglycerin or Other Heart Drug
Latex or Rubber Products
Congenital Heart Disease
Heart Trouble
Low Blood Pressure
Low Blood Sugar
Tumors or Growths
ImplantsProstheses
Steroids Cortisone etc
Anticoagulants Blood Thinners
Tranquilizers
Insulin or Oral Antidiabetic Drugs
Pain Relievers Aspirin Motrin Aleve Ibuprofen etc
High Blood Pressure Medications
Any Other Painkillers
Penicillin
Any Other Antibiotics Sodium Pentothal
Other Allergies or Reactions
Aspirin or Ibuprofen
Codeine
Under care of Physician
Serious Illness
Treatment for Osteoporosis or Chemotherapy
History of alcohol or chemical dependancy
Problems with previous dental treatment
Rheumatic Fever or
Bronchitis
Liver Disease
Radiation Xray Treatment for
Jaundice
Pneumonia
Hepatitis
Gallbladder Trouble
Tuberculosis
Cardiovascular Disease
Kidney Disease
STDs HIV or AIDS
Chest Pain
Heart Attack
Thyroid Disease Goiter
Shortness of Breath
Jaw Joint ClickingPopping
Severe Coughing
Heart Murmur
High Blood Pressure
Pain Near Ear
Seizures
Mitral Valve Prolapse
Arthritis
Difficulty Opening Mouth
Convulsions
Coronary Artery Disease
Diabetes
Grind or Clench Teeth
Epilepsy
Stroke
Sinus or Nasal Problems
Fainting
Angina
Delay in Healing
Stomach Ulcers or Colitis
Dizziness
Palpitatio
Glaucoma
Bleeding Disorder
Heart Surgery
Anemia
Lung Disease
Knee
Any Disease Drug or Transplant
Bleeding Tendency
Asthma
Other
Blood Transfusion
Emphysema
Heart Valve
Bruise Easily
Smoke or Chew Tobacco
Chronic Cough
Pacemaker
Pregnanat
Nursing
Local Anesthesia Novocain etc
Chronic FatigueNight Sweats
Hip
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