Deutsch Website, wo Sie Qualität und günstige Viagra Lieferung weltweit erwerben.

Zufrieden mit dem Medikament, hat mich die positive Meinung propecia kaufen Viagra empfahl mir der Arzt. Nahm eine Tablette etwa eine Stunde vor der Intimität, im Laufe der Woche.

114 Lake Road, Northcote, Auckland.
Tel: 09 480 6629
Please be as accurate as possible when completing this questionnaire. The information you provide is kept
Title________ First names_______________________ Surname___________________________________________

Date of birth ______/_______/___________ Occupation__________________________________________________

Postal Address________________________________________________________________ Postcode_____________

Telephone: Mobile__________________________ Work _____________________ Home_______________________

Email _________________________________________ I wish to receive emails regarding news or promotions

Name and contact of next of kin ______________________________________________________________________

Were you referred to the practice by one of our patients? (Please name) _____________________________________

How did you hear about us?__________________________________________________________________________

Name of Last Dentist_____________________________________________ Date of last visit_____________________

Name of Medical Practitioner_______________________________________Location___________________________

Are you in any pain presently? Y/N Do you need to take antibiotics prior to dental treatment? Y/N

Please list the medications you are currently taking.______________________________________________________

Is there anything about your teeth you would like to discuss with the dentist?______________________________

Do you have any allergies to medicines, anaesthetics, latex, penicillin? Please list _____________________________

Are you a smoker? Y/N Are you pregnant? Y/N If so, how many months?______________________

Please tick if you have had any of the following:

Anaemia Depressive Illness Heart Murmur Nervous problems

Rheumatic Fever

Arthritis Diabetes Hepatitis A,B,C Osteoporosis Severe headaches

Asthma Epilepsy/Seizure Pacemaker Stroke High Blood Pressure

Cancer Excessive Bleeding Tuberculosis Prosthetic Joint Low Blood Pressure
IV/Aids C
hest Problems Gast
ric issues
Hearing/Sight issues
art conditions Liv
er/Kidney problems Reac
tion to Anaesthetic

CONSENT FOR TREATMENT: I authorise the dentist/designated staff to perform all recommended treatment deemed

appropriate by the dentist to make a thorough diagnosis. I agree to be responsible for payment of all services
rendered. I understand payment is due at time of service. Cost incurred in relation to collection of overdue accounts
will be charged to the account holder. By signing below I understand and accept these terms and conditions.

Signed by Patient/Parent/Guardian________________________________________Date ____/______/__________



¿Cómo escribir un artículo científico? “Si un hombre puede organizar sus ideas, Resumen: Uno de los grandes problemas que enfrenta un investigador surge cuando tiene que dar a conocer sus resultados o socializarlos, pues escribir no resulta tarea fácil, máxime cuando el mundo actual se mueve en una especie de perfeccionamiento del vocabulario científico y surgen palabras muy


Pediatric Urology – Patient Education Handout Daytime Wetting and Voiding Dysfunction in Children What are the symptoms? • urge incontinence – your child leaks on the way to the bathroom, often complains of • non-specified incontinence – your child leaks without sensation or warning • urinary frequency – child voids at least every 2 hours (interferes with school) • l

Copyright © 2010-2014 Health Drug Pdf