Are you currently receiving treatment from a doctor, hospital or clinic?
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Are you Currently Pregnant?
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Are you currently taking any pills or medicines?
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Are you carrying a warning card?
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Do you duffer from allergies to penicillin or any medicines (e.g. antibiotics), substances (e.g. latex/rubber) or foods?
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Do you suffer from asthma, hay fever or eczema?
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Do you suffer from fainting attacks or epilepsy?
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Do you suffer from Diabetes?
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Have you ever had liver disease (e.g. jaundice, hepatitis) or Kidney disease?
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Do you suffer from bruising or persistent bleeding following injury, tooth extraction or surgery?
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Do you suffer from Osteoporosis?
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Have you ever gad any other Serious illness?
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Have you ever gad a bad reaction to general or local anaesthetic?
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Have you ever had a joint replacement or other implant?
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Have you ever had a heart condition or heart surgery?
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do you regularly drink more than 14 units of alcohol per week?
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Do you use any tobacco products?
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Is there any other information which your dentist might need to know about, such as self-prescribed medicines (e.g. Aspirin)?
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