1. Within the last 3 years have you consulted with a physician or received medical treatment other than a routine check-up which has been completely clear? *
2. Have you ever been admitted to any:*
3. Have you been informed of abnormalities in laboratory tests performed in the last 3 years?*
4. For women : Have you ever had any complications of pregnancy or childbirth?
1. Are you currently under medical supervision or taking prescribed medications for any condition?
2. Do you have a birth defect or congenital abnormality or do you suffer from a chronic disease?
1. Are any medical or surgical procedures recommended, scheduled and/or contemplated?
2. Is there any oral/dental condition needing treatment (other than normal cleaning & routine examinations)?
Do you have a doctor who holds your medical records?
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StudyProtect Team »