Have you ever had any of the following? Please indicate

I have completed this questionnaire to the best of my knowledge & understanding that failure to make a full disclosure may place me at undue medicalrisk. I understand that notes, radiographs (x-rays) or models relating to my treatment may need to be sent to other dental practitioners to aid them inmy treatment & consent to this. I also give my permission for practice to use above contact details to send me appointment & check- up reminders.