DENTAL FORM

Dossier médical dentaire -ang

Personal informations

Medical History

Are you allergic to any medication?
Are you under medical treatment?
Have you had problems with anesthesia?
Are you allergic to any type of food or latex?
Do you take any vitamins or herbal supplements?
Do you smoke?
Do you drink alcohol?
Do you have glycaemia?
Do you have blood pressure ?

Dental History

Are you currently experiencing pain?
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