11. Have you had surgery or x-ray treatment for tumor, growth, or other condition of your mouth or lip?

Yes/SiNo

L. Other drug or medicine

13. Are you taking or scheduled to begin taking either of these medications?

Alendronate (Fosamax) for OsteoporosisRisedronate (Actonel)

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?

Yes/SiNo

Date treatment began:

15. Are you allergic or have you reacted adversely to any of the following?

Local anesthetics/Anestesia localPenicillin or other antibiotics/Antibioticos o penicilinaSulfa drugs/Drogas con sulfasLatex or rubber products/Es usted alergico a latex o productos de huleBarbiturates, sedatives or sleeping pills/Barbituricos, sedantes o pastillas para dormirAspirin/AspirinaIodine/YodoCodeine or other narcotics/Codeina u otros narcoticos

Other allergies

16. Have you taken the diet medication Redux (Fen-Phen)?

Yes/SiNo

17. Do you have any disease, condition, or problem not listed above that you think I should know about?

Yes/SiNo

18. Are you employed in any situation which exposes you regularly to x-rays or other ionizing radiation?

Yes/SiNo

19. Are you wearing contact lenses?

Yes/SiNo

20. Have you ever had any of the following conditions?

HerpesHepatitisTuberculosisHIV/AIDS