Bermudez Dental Clinic | Eat wisely. Smile nicely.

Medical Information Form

For your safety, please complete this short medical information form before your appointment. Your answers will help our dentist review your health condition and provide safe and appropriate dental care.

Do you have any allergies?

Yes

No

If Yes, please specify your allergy.

Are you currently taking prescription or non-prescription medications?

Yes

No

If Yes, please list the medications you are currently taking.

Additional Medical Information

I confirm that the medical information I provided is accurate.

Contact & Booking

Schedule Your Visit With Confidence

Booking your dental appointment should be simple and stress-free. Whether you’re visiting for a checkup, braces, dentures, or teeth whitening, our team is here to make the process smooth and comfortable from start to finish.

Reach out online, send us a message, or contact us directly — we’ll guide you every step of the way.

Clinic Contact Information

Have questions? We’re happy to help.

Phone / SMS: 0945 539 5303
Email: [email protected]
Clinic Hours:
Monday – Saturday: 8:30 AM – 5:00 PM
Sunday: By appointment

Contact Us

We respond promptly to appointment requests and inquiries.

Location

Zone 5 Taft St, Bangued, Abra 2800

Appointment Request

Fill out the form to request your visit. Our team will confirm your schedule and provide next steps to prepare for your appointment.

By submitting this form, patients can acknowledge that they understand how their information will be used.

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