{"id":13973,"date":"2021-09-01T01:41:23","date_gmt":"2021-09-01T01:41:23","guid":{"rendered":"https:\/\/parogatineau.ca\/?page_id=13973"},"modified":"2022-12-08T14:33:07","modified_gmt":"2022-12-08T19:33:07","slug":"questionnaire-medicale","status":"publish","type":"page","link":"https:\/\/parogatineau.ca\/en\/questionnaire-medicale\/","title":{"rendered":"Questionnaire M\u00e9dicale"},"content":{"rendered":"
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Medical Questionnaire<\/h1>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t
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\n\t\t\t\n\t\t\t\t\t\t<\/span>\n\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t
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Use our secure<\/strong><\/span> online form to complete your medical questionnaire. It's simple, easy and quick!<\/p>\n<\/div>\n<\/div>\n

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This questionnaire will allow the periodontist and his team to provide the best possible care and to reduce the risk of medical complication.<\/p>\n

It's in the patient's interest to respond carefully and to advise of any change in their medical condition.<\/strong><\/p>\n

Person responsible for the protection of personal information: Julie Hayes 819-525-9255<\/p>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t

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    <\/ul>\n<\/div>\n
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    \n<\/fieldset>\n
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    PERSONAL INFORMATION
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    * = required fields\n\t<\/p>\n

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    Name of insurance company<\/span>\n\t\t\t\t\t<\/p>\n<\/p><\/div>\n

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    <\/span>\n\t\t\t\t\t\t<\/p>\n<\/p><\/div>\n<\/p><\/div>\n<\/p><\/div>\n<\/p><\/div>\n<\/p><\/div>\n

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    Name of insurance company<\/span>\n\t\t\t\t\t<\/p>\n<\/p><\/div>\n

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    <\/span>\n\t\t\t\t\t\t<\/p>\n<\/p><\/div>\n<\/p><\/div>\n<\/p><\/div>\n<\/p><\/div>\n<\/p><\/div>\n

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    MEDICAL HISTORY
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    Specify<\/span>\n\t\t\t\t\t<\/p>\n<\/p><\/div>\n

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    <\/span>\n\t\t\t\t\t\t<\/p>\n<\/p><\/div>\n<\/p><\/div>\n<\/p><\/div>\n<\/p><\/div>\n<\/p><\/div>\n

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    Specify<\/span>\n\t\t\t\t\t<\/p>\n<\/p><\/div>\n

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    <\/span>\n\t\t\t\t\t\t<\/p>\n<\/p><\/div>\n<\/p><\/div>\n<\/p><\/div>\n<\/p><\/div>\n<\/p><\/div>\n

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    Specify<\/span>\n\t\t\t\t\t<\/p>\n<\/p><\/div>\n

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    <\/span>\n\t\t\t\t\t\t<\/p>\n<\/p><\/div>\n<\/p><\/div>\n<\/p><\/div>\n<\/p><\/div>\n<\/p><\/div>\n

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    Specify<\/span>\n\t\t\t\t\t<\/p>\n<\/p><\/div>\n

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    <\/span>\n\t\t\t\t\t\t<\/p>\n<\/p><\/div>\n<\/p><\/div>\n<\/p><\/div>\n<\/p><\/div>\n<\/p><\/div>\n

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    If yes, explain<\/span>\n\t\t\t\t<\/p>\n<\/p><\/div>\n

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    <\/span>\n\t\t\t\t\t<\/p>\n<\/p><\/div>\n<\/p><\/div>\n<\/p><\/div>\n<\/p><\/div>\n

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    Specify<\/span>\n\t\t\t\t\t\t<\/p>\n<\/p><\/div>\n

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    <\/span>\n\t\t\t\t\t\t\t<\/p>\n<\/p><\/div>\n<\/p><\/div>\n<\/p><\/div>\n<\/p><\/div>\n<\/p><\/div>\n<\/p><\/div>\n

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    If yes, cig.\/day and nb. years<\/span>\n\t\t\t\t\t<\/p>\n<\/p><\/div>\n

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    <\/span>\n\t\t\t\t\t\t<\/p>\n<\/p><\/div>\n<\/p><\/div>\n<\/p><\/div>\n<\/p><\/div>\n<\/p><\/div>\n

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    Frequency:<\/span>\n\t\t\t\t\t\t<\/p>\n<\/p><\/div>\n

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    <\/span>\n\t\t\t\t\t\t\t<\/p>\n<\/p><\/div>\n<\/p><\/div>\n<\/p><\/div>\n<\/p><\/div>\n<\/p><\/div>\n<\/p><\/div>\n

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    Specify<\/span>\n\t\t\t\t\t<\/p>\n<\/p><\/div>\n

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    <\/span>\n\t\t\t\t\t\t<\/p>\n<\/p><\/div>\n<\/p><\/div>\n<\/p><\/div>\n<\/p><\/div>\n<\/p><\/div>\n

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    DENTAL HISTORY
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    \n\t\t\t<\/p>\n<\/p><\/div>\n<\/p><\/div>\n<\/div>\n

    <\/div>\n<\/form>\n<\/div>\n<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<\/div>","protected":false},"excerpt":{"rendered":"

    Medical Questionnaire<\/p>","protected":false},"author":1,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"footnotes":""},"class_list":["post-13973","page","type-page","status-publish","hentry"],"yoast_head":"\nQuestionnaire M\u00e9dicale | Paro Gatineau<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/parogatineau.ca\/en\/questionnaire-medicale\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Questionnaire M\u00e9dicale | Paro Gatineau\" \/>\n<meta property=\"og:description\" content=\"Questionnaire M\u00e9dical\" \/>\n<meta property=\"og:url\" content=\"https:\/\/parogatineau.ca\/en\/questionnaire-medicale\/\" \/>\n<meta property=\"og:site_name\" content=\"Paro Gatineau\" \/>\n<meta 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