JMG Questionnaire Pro

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Medical & Dental History Questionnaire

The following information is required to enable us to provide you with the best possible dental care. All information is strictly private and is protected. The dentist will review the questions and explain any that you do not understand. Please fill in the entire form.
  1. Are you being treated for any medical condition at the present or have been treated within the past year?

    • Ja
    • Nein
    1. If so, why?