Health Questionnaire & Consent Form Sample Contracts

Kokoro Clinic — Health Questionnaire & Consent Form

Health Questionnaire & Consent Form • November 3rd, 2017

• Contract Type
  Health Questionnaire & Consent Form
• Filed
  November 3rd, 2017

…………………………………………………………………………………………………………………………………………………………………………………………………….. General anaesthetic—incl when & why ………………………………………………………………………………………………………………………………………. Dental work ………………………………………………………………………………………………………………………………………………………………………………… Headaches/Migraine …………………………………………………………………………………………………………………………………………………………………… Stroke/TIA/Dizziness/Fainting/Balance ……………………………………………………………………………………………………………………………………….. Other Investigations/Procedures …………………………………………………………………………………………………………………………………………………