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Dental History

Check If you have had problems with any of the following

Medical History

Have you ever use a bisphosphone medication? Common brand names are Fosamax, Actonel, Atevia, Didronel, Boniva.

Have you ever taken any of the group of drugs collectively referred to as "fen-phen?" These include combination of lonimin, Adipex, Fastin (brand names of phentermine), Pondimin (fenfluramine) and Redux (dexfenfluramine).

Have you had any serious illnesses or operations?

Have you ever had a blood transfusion?

(Women) Are you pregnant?


Taking birth control pills?

Check If you have or have had with any of the following :

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