Medical History Update

Dental Implants From As Little As $1,500*

(Includes The Implant - Additional Fees Apply For Prosthetic Component & Bone Grafting)

Medical History

Medical History

Please check the appropriate boxes

Heart Conditions
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Rheumatic Fever
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Blood Pressure Problems
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Asthma
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Blood Disorders
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Bleeding Problems
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Kidney Problems
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Hepatitis / Liver Disease / HIV
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Diabetes
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Radiotherapy / Chemotherapy
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Local Anaesthetic Problems
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Other Illness / Disability / Epilepsy
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Are You Taking Any Medication?
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