11. Have you had surgery or x-ray treatment for tumor, growth, or other condition of your mouth or lip?
12. Are you taking any of the following?
L. Other drug or medicine
13. Are you taking or scheduled to begin taking either of these medications?
14. Since 2001, were you treated or are you presently scheduled to begin treatment with the intravenous Biphosphonates (Aredia or Zometa ) for bone pain, Hypercalcemia or skeletal complications resulting from Paget’s Disease, Multiple Myeloma or Metastatic cancer?
Date treatment began:
15. Are you allergic or have you reacted adversely to any of the following?
Other allergies
16. Have you taken the diet medication Redux (Fen-Phen)?
17. Do you have any disease, condition, or problem not listed above that you think I should know about?
18. Are you employed in any situation which exposes you regularly to x-rays or other ionizing radiation?
19. Are you wearing contact lenses?
20. Have you ever had any of the following conditions?