Epstein Secrets

scopy within the last 6 weeks? If yes. date of exam YES NO DO YOU HAVE ANY OF THE FOLLOWING IN YOUR BODY? 0 Brain/Aneurysm Clips 0 Pacemaker, Pacer Wires or Defibrillator if yes. make% year O Any Metallic fragment or foreign body O Ear Implants or Hearing Aids O Electrical Stimulators O Implant/Prosthesis O

fragment or foreign body O Ear Implants or Hearing Aids O Electrical Stimulators O Implant/Prosthesis O Infusion Pumps 0 Coils. Catheters. Filters or Wires in blood O Artifical Limbs or Joint Replacement O Tattooed Eyeliner O Artificial Heart Valves O Stents If yes, please provide date of implant

ed? If yes, when? Any surgery on your eyes, ears brain or heart? DO YOU HAVE ANY OF THE FOLLOWING IN YOUR BODY? Brain/Aneurysm Clips Pacemaker, Pacer Wires or Defibrillator if yes, make\ year Ear Implants or Hearing Aids Electrical Stimulators Implant/Prosthesis Infusion Pumps Coils. Catheters. Fitters or Wires in

res or Defibrillator if yes, make\ year Ear Implants or Hearing Aids Electrical Stimulators Implant/Prosthesis Infusion Pumps Coils. Catheters, Filters or Wires in blood • Artifical Limbs or Joint Replacement Tattooed Eyeliner Artificial Heart Valves Stents If yes, please provide date of implant: Magnet

within the last 6 weeks? If yes, date of exam YES NO DO YOU HAVE ANY OF THE FOLLOWING IN YOUR BODY? 0 0 Brain/Aneurysm Clips 0 0 Pacemaker, Pacer Wires or Defibrillator if yes, make\ year 0 0 Any Metallic fragment or foreign body CI O Ear Implants or Hearing Aids 0 C7 Electrical Stimulators 0 0 Implant/Pr

n body CI O Ear Implants or Hearing Aids 0 C7 Electrical Stimulators 0 0 Implant/Prosthesis CI 0 Infusion Pumps 0 0 Coils. Catheters. Filters or Wires in blood 0 0 Artifical Limbs or Joint Replacement CI 0 Tattooed Eyeliner 0 O Artificial Heart Valves 0 0 Stents If yes, please provide d