Have you ever had a local anesthetic? (Lidocaine, etc.)
Have you ever had an unfavorable reaction to a local anesthetic?
Have you had any serious trouble associated with any previous dental treatment?
When was your last x-ray?
When was your last dental treatment?
Does dental treatment make you nervous?
Have you ever had Nitrous Oxide Analgesia (gas) during dental treatment?
Do you have any Biomedical or tissue implants such as:
Do you use tobacco?
If so, how often?
Do you use alcohol?
If so, how much?
Do you use drugs?
If so, what type and how much?
Have you traveled abroad recently or experienced any health related symptoms after traveling abroad?
Have you spent any extended period of time in foreign countries?
Have you ever experienced diarrhea for extended periods of time? (2 to 3 months)
Have you ever been treated by any of the following?
274 Madison Ave, Suite 202, Manhattan, NY, 10116
Tel.: 718-645-7000 | E-mail: firstname.lastname@example.org