Practice Dr. Marco Ackermann

Health questionnaire
In order to guarantee a dental treatment optimally adapted to your individual needs, we would like to collect some medical and personal information prior to your first appointment.

If you wish, you may download an English copy of the health questionnaire as PDF-file and complete it comfortably at home. There are two options:

a) Handwriting

You print the form, fill in the requested information with a pen, and bring the document with you.

b) Typing on your computer

You may also open the document with the free Adobe Reader, fill in the requested information on your screen and send the completed questionnaire to ackermann@pgwolfbach.ch. Your document just needs to be signed once you arrive in our practice.

Please use only Adobe Reader when completing your form: Alternative PDF-readers are unable to save your personal data. You'll find more complete instructions for the Adobe Reader here (in German).