Medical Health Questionnaire for Oral & Maxillofacial Surgery

Are you currently under the care of a physician

Do you have any known allergies

Have you had any recent surgeries/hospitalisations

Do you currently take any prescription medications

Do you take any over-the-counter medications/supplements or herbal remedies

Do you drink alcohol

Do you have a history of drug/alcohol abuse

Do you smoke

Have you had previous oral surgeries (eg extractions, implants, gum surgery)

Do you/your family have a history of complications with general anaesthesia

Do you experience excessive bleeding when injured or have a history of clotting problems

Have you ever taken or are currently taking oral steroids – cortisone, prednisolone or hydrocortisone

Have you ever taken medication for osteoporosis/hypercalcemia/Paget’s disease in the past 10 years

Have you ever had heart surgery, valve replacement, hip or joint replacements or pacemaker

(Females) Are you currently pregnant or planning a pregnancy

(Females) Are you currently breastfeeding