GENERAL MEDICAL QUESTIONNAIRE
IF NO, HAVE YOU EVER SMOKED?
DO YOU TAKE REGULAR EXERCISE?*
ARE YOU CURRENTLY PREGNANT OR BREAST FEEDING?*
ARE YOU CURRENTLY TAKING OR HAVE YOU EVER TAKEN ANY OF THE FOLLOWING MEDICATIONS?*
ARE YOU ALLERGIC TO ANY OF THE FOLLOWING?*
ARE YOU CURRENTLY UNDERGOING DESENSITISATION TREATMENT?*
HAVE YOU SUFFERED FROM ANY OF THE FOLLOWING CONDITIONS?
DO YOU SUFFER FROM MYASTHENIA GRAVIS OR EATON-LAMBERT SYNDROME?*
HAVE YOU PREVIOUSLY HAD ANY MAJOR, MINOR OR COSMETIC SURGERY?*
HAVE YOU RECENTLY BEEN EXPOSED TO SUN BEDS, HAD DERMABRASION, SKIN PEELS OR LASER RESURFACING?*
HAVE YOU HAD ANY TREATMENT WITH BOTULINUM TOXIN OR DERMAL FILLERS (TEMPORARY OR PERMANENT)?*
DO YOU HAVE A PHOBIA OF BLOOD OR NEEDLES?*
DO YOU HAVE A HISTORY OF ANAPHYLACTIC SHOCK (SEVERE ALLERGIC REACTION)?*
ARE YOU CURRENTLY RECEIVING ANY MEDICAL TREATMENT?*
ARE YOU CURRENTLY TAKING ANY DIETARY SUPPLEMENTS OR MEDICATIONS?*
ARE YOU CURRENTLY UNDERGOING ANY DENTAL TREATMENT?*
ARE YOU PRONE TO FAINTING?*
ARE YOU PRONE TO BRUISING?*
DO YOU SUFFER FROM KELOID OR HYPERTROPHIC SCARRING?*
ARE YOU PRONE TO BLEED EASILY OR SUFFER FROM ANY BLEEDING DISORDERS?*
