HAVE YOU BEEN TREATED FOR ANY OF THE FOLLOWING?
If you responded YES to any of the above, please give pertinent information:
Are you in good health?
If No please explain
Do you have any history of major illness and/or operations?
List any drugs or medication now being taken: Please give reasons:
Are you currently taking or have you been given intravenous bisphosphonates (such as Zometa or Aredia) for bone cancer?
Are you currently taking or have you been given oral or intravenous bisphosphonates (such as Fosamax, Actonel, Boniva, Reclast, Skelid, Didronel, or Bonefos) for osteoporosis, osteopenia, or other uses?
List any allergies or drug sensitivities (Including sensitivity to metals):
Do you have a tendency to colds?
Have your tonsils or adenoids been removed?
If so, at what age?
(Women) Are you pregnant?