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Current infectious disease/fever/ infection YES NO <br />Epilepsy YES NO <br />Are you taking blood thinning medications or fish oil? YES NO <br />Are you pregnant? YES NO <br />Do you have a history of allergic reactions to latex? YES NO <br />Do you have a history of cardiac valve disease? YES NO <br />Do you have a history of allergic reactions to topical numbing agents? YES NO <br />Do you have a history of allergic reactions to antibiotics? YES NO <br />Do you have a pacemaker? 'YES NO <br />Do you have a problem with healing of wounds? YES NO <br />Have you consumed drugs or alcohol in the last 24 hours? YES NO <br />Are you required to take antibiotics prior to treatment due to a special condition? <br />YES NO <br />In the last 14 days did you undergo surgery, in which you were exposed to any medical <br />interventions? YES NO <br />