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Have you ever been diagnosed with the following
conditions:
— Mitral Valve Prolapse
— Heart Murmur
— Rheumatic Fever
Have you ever had:
— Heart Valve Replacement
— Joint Replacement
— Cardiac Surgery, within the last year
Have you ever taken the following drugs:
— Phen-Fen
— Redux
If you have answered yes to any of the above questions,
please contact Dr. Cichon prior to making your appointment.
Otherwise, please download our health care information form
complete it, and bring it along to your appointment.
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