Dental implants Dental Holiday Cosmetic Dentisty
Dental Travel Implants Dental Dental Treatment Private Dentistry Cosmetic
Travel Dental Private Dental treatment
Emergencies: 966 017 783
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Looking for dental implants, private dental treatment, orthodontic treatment, cosmetic dentistry or teeth whitening?
We offer a full range service with a competent and qualified team.
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2. Personal Data:
 
- Name:
 
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- Gender: Male       Female
 
- Telephone:
 
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3. General Health:
 
- Age: years
 
- Do you take any medication? Yes      No What for:
 
- Are you allergic to any drugs or other substances? Yes      No Comment:
 
- Have you been ill or been operated recently? Yes      No Comment:
 
- Have you been depressed lately? Yes      No Comment:
 
- Do you smoke? Yes      No How much?
 
- How would you describe previous dental treatment? Very Good      Good      Bad      Very Bad


4. Dental Health:
 
- Any missing teeth? Yes      No Where?
 
- Wearing removeable dentures? Yes      No  
 
- Sensitive teeth? Yes      No  
 
- Loose / loosening teeth? Yes      No  
 
- Gum retration? Yes      No  
 
- Do you grind your teeth at night? Yes      No
 
- How far can you open your mouth? One finger      Two fingers      Three fingers


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