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Page 1: oakbrookdentalpc.com...WOMEN ONLY Are you. Pregnant? Number of weeks. Taking birth control pills or hormonal replacement? Nursing? Metals Latex (rubber) Iodine Hay fever/seasonal Animals

Page 2: oakbrookdentalpc.com...WOMEN ONLY Are you. Pregnant? Number of weeks. Taking birth control pills or hormonal replacement? Nursing? Metals Latex (rubber) Iodine Hay fever/seasonal Animals

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