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Guest
3
4
5
Do you have a pace maker?
Yes
No
Are you pregnant or is there a risk that you are pregnant?
Yes
No
Do you have a cochlear implant?
Yes
No
Do you suffer from renal insufficiency of any kidney disease?
Yes
No
I don't know
Do you have a implanted drug pomp, implanted neurostimulator or implanted blood sugar sensor?
Yes
No
Are you likely to have metal parts in or around the eyes?
Yes
No
Do you have surgical clips or stents?
Yes
No
I don't know
Have you ever undergone heart surgery?
Yes
No
I don't know
Have you previously undergone brain surgery?
Yes
No
I don't know
Do you have an adjustable cerebral drain (ventriculoperitoneal diversion with adjustable valve)?
Yes
No
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