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Reason for Visit
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Are you pregnant
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New Medications?
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Are you nursing?
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Are you prone to Cold Sores?
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Signs of Infection
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Numbing Cream?
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Risks and Benefits discussed
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Nerve Block Performed
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Filler Lot Number
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New Medications?
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Facial Anatomy
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Any known allergies?
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Consult Form
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If yes, please state all known allergies.
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