Appointment Request

Health History Form

After printing and completing the form below, you may provide it to our front desk at the time of your child’s first appointment. Otherwise, we ask that you please arrive 15-30 minutes prior to your scheduled appointment time, so that this information may be gathered in our office. Please understand that your child’s first appointment cannot begin until this information has been collected and reviewed by the doctor. Thank you.

What should be expected for my child's first dental appointment?

  • A Complete Exam by Dr. Ruelf
  • Diagnostic Radiographs
  • Cleaning (prophylaxis)
  • Fluoride Application

Based on his exam, Dr. Ruelf will explain the dental treatment that is indicated for you child. If applicable, please remember to bring a complete list of any medications your child may be taking as well as your family’s dental insurance policy information. We look forward to meeting with you and your family soon!

Office Hours:

Monday: 8:00 am – 4:30 pm

Tuesday: 8:00 am – 4:30 pm

Wednesday: 8:00 am – 4:30 pm

Thursday: 8:00 am – 4:30 pm

Friday: CLOSED

1308 West Fletcher Ave
Tampa, FL 33612