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Do you have any cardiac conditions or do you take antibiotics before dental procedures?
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Do you have any respiratory/lung conditions?
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Do you have any neurological/head/neck conditions?
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Do you have any stomach/gastrointestinal conditions?
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Do you have any kidney/urinary/live/autoimmune conditions?
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Do you have any musculoskeletal conditions?
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Do you have any other medical conditions?
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If you said yes to any of the above please explain:
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Are you pregnant or breastfeeding?
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Have you ever received IV treatments in the past?
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Have you ever had an adverse reaction to an IV?
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Have you ever been treated for an alcohol or drug overdose?
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Do you use alcohol/tobacco/drugs?
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How often do you use alcohol/tobacco/drugs?
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Have you ever had cancer or received chemotherapy/radiation?
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Have you ever fainted?
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If you said yes to any of the above please explain:
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