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Signature of patient/parent if minor DuLac Dental ES Medhx -DuLac 9/27 Although dental personnel primarily treat the area in and around your mouth your mouth is a part of your entire body. Health problems that you may have or medication Are you under a physician s care now Have you ever been hospitalized or had a major operation Have you ever had a serious head or neck injury Are you taking any medications pills or drugs Are you on a special diet Do you use tobacco Do you use controlled...
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