Table 1.

Questionnaire provided to patients

Questionnaire items	Yes	No	Comment
1. Have you ever been hospitalized or undergone surgery?			Site:
2. Are you currently being treated by a doctor?
3. What kind of medications are you currently taking?			Drug:
4. Have you ever had side effects from injections or medicines?
5. Are you bleeding excessively or are you taking anticoagulants?
6. Have you ever had tuberculosis or a sexually transmitted infection?
7. Do you have hypertension?			Blood pressure: /
8. Do you have hepatitis or jaundice?
9. Do you have heart disease?
10. Do you have kidney disease?
11. Do you have diabetes mellitus?			Blood sugar test
12. Are you taking osteoporosis medications?			Intravenous/ oral/ both Duration of medication:
13. Do you have trouble breathing or have stomach problems?
14. Are you pregnant?
15. Do you have dementia?
16. Do you have thyroid disease?