History and Intake Form - Central Dermatology Center

(please list all current. medications & dosage, including those used as needed, herbals and supplements ... Allergy to lidocaine. Allergy to adhesive. Allergy to topical antibiotic ointments. Rapid heartbeat with epinephrine. Yeast infe. ctions with antibiotics. Gastrointestinal upset with antibiotics . ................
................