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Page 1: you ever had trouble getting numb or had reactions to local anesthetic? Did you ever have braces, orthodontic treatment or had your bite adjusted? Have you had any teeth removed? Gums
Page 2: you ever had trouble getting numb or had reactions to local anesthetic? Did you ever have braces, orthodontic treatment or had your bite adjusted? Have you had any teeth removed? Gums
Page 3: you ever had trouble getting numb or had reactions to local anesthetic? Did you ever have braces, orthodontic treatment or had your bite adjusted? Have you had any teeth removed? Gums
Page 4: you ever had trouble getting numb or had reactions to local anesthetic? Did you ever have braces, orthodontic treatment or had your bite adjusted? Have you had any teeth removed? Gums
Page 5: you ever had trouble getting numb or had reactions to local anesthetic? Did you ever have braces, orthodontic treatment or had your bite adjusted? Have you had any teeth removed? Gums
Page 6: you ever had trouble getting numb or had reactions to local anesthetic? Did you ever have braces, orthodontic treatment or had your bite adjusted? Have you had any teeth removed? Gums

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