Medical History Form

If you have any questions, please call our office at 204-837-4517.

Medical History

Please answer yes or no to the following

List all medications, supplements, and or vitamins taken within the last two years

PLEASE ADVISE US IN THE FUTURE OF ANY CHANGE IN YOUR MEDICAL HISTORY OR ANY MEDICATIONS YOU MAY BE TAKING

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What Our Patients Say About Us

Dr. Shah is wonderful, he did an amazing job on my veneers! I finally have a smile that I love, for the first time in my life. The staff here are always so friendly and accommodating, and ever since I started coming here, I actually find myself looking forward to dental appointments! I highly recommend Westwood Dental

– LISA DARKWING

Where To Find Revive Dental At Westwood 

3216 Portage Ave

Winnipeg, MB

R3K 0Y8

204-837-4517

Revive Dental Winnipeg

The first step towards a beautiful, healthy smile is to schedule an appointment. Please contact our office by phone. Our scheduling coordinator will confirm your appointment.