Medical History Forms For our new patients, we have made available all of the necessary forms for you to download and fill out in the convenience of your home. Instructions: 1. Please download the Adobe Acrobat PDF forms by clicking on the below download button. 2. Please print the forms. 3. Please fill out the forms completely and have ready when you arrive for your first appointment. Note: Adobe Acrobat is required for viewing and printing this file. If you do not have Adobe Acrobat installed in your computer, please click here.

5604 PGA BOULEVARD, SUITE 209 PALM BEACH GARDENS, FL 33418 (561) 627-7090 • FAX (561) 691-3311 © COPYRIGHT 2006, DAVID S. BENSON D.M.D. ALL RIGHTS RESERVED. THIS MATERIAL MAY NOT BE PUBLISHED, BROADCAST, REWRITTEN OR DISTRIBUTED. WEB DESIGN BY: BIG PICTURE GRAPHICS, INC.