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Are you taking or have you ever taken any of the following medications please circle if yes / / / Aspirin / 8. All employees of Hampton Oral Facial Surgery shall be held harmless for any inaccuracy or omission of information provided to this office by the Patient s insurance carrier. Please list other medications you are taking Have you had or do you currently have Damaged heart valves High Blood Pressure High cholesterol Low Blood Pressure Chest pain / Angina Heart Attacks Irregular Heart...

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