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Ben Thompson, DMD...Cold Sores/Fever O Yes O No Yes NO Heart Pacemaker Heart Trouble/Disease O Yes No If yes Have you had any serious illness not listed above? Yes No Corrments; To

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Page 1: Ben Thompson, DMD...Cold Sores/Fever O Yes O No Yes NO Heart Pacemaker Heart Trouble/Disease O Yes No If yes Have you had any serious illness not listed above? Yes No Corrments; To

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