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  • VITAL TOTAL HEALTH Medical Group, Inc.

    Walnut Creek - San Francisco - Oakland - Pleasanton - Folsom - Beverly Hills

    www.VitalTotalHealth.com www. VitalOncall.com

    Central Phone and Fax (925) 388-9800

  • SUBSTANCE USE QUESTIONNAIRE

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  • ALLERGIES TO DRUGS OR ANESTHESIA?*
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  • DO YOU TAKE ANY MEDICATIONS or SUPPLEMENTS?*
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  • Have you tried any drugs in the past for your problem?*
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