PDF www.highlandsranchdentalcare.com
Are you aware of having an allergic or adverse reaction to any medication. dental anesthetic or substance?..... If yes, please list ... Chronic Cough. Yes No Yes No Asthma... Yes No Hay Fever.... Yes No Gold Or Metal Allergy.. Yes No Red Dye Allergy.... . Yes No Acrylic Allergy. . Yes No ................
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