Thank you for visiting Surgical Services International Dental Consultation Form. We will forward your medical details to your surgeon who will reply with his/her clinical evaluation and any questions he may have for you.
Please describe exactly which procedures you are interested in and specify according to the chart the following information that pertains to your case:
List any medications you take including herbal medications :
List all major illnesses or injuries
(diabetes, high blood pressure, emphysema, heart attacks, etc):
(rosacea, skin cancer, psoriasis, etc.)
(MS, stroke, seizures, etc.)