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Demo site · opsforma · The clinic is fictional and nothing is sent.

Mon–Fri 9:00–20:00

[object Object]Book an appointment

+381 60 000 10 01

Before your first visit

Health questionnaire

You fill in the questionnaire before your first visit, at home and without rushing; it takes about 5 minutes. We ask about your health, medicines and allergies because they determine which anaesthetics and medicines are safe for you. The questions about your teeth help us prepare, so there is more time to talk at the appointment. Your answers are confidential and kept as part of your patient record.

Demo: your answers are not saved or sent anywhere. After submitting you only see what would happen on a real site.

Your details
General health
How would you describe your general health?
Do you have any of these conditions?

Some conditions affect the choice of anaesthetic and how you heal after a procedure.

Are you pregnant or breastfeeding?

If so, we postpone any X-rays that aren't essential and choose medicines that are safe for you and your baby.

Do you smoke?

Smoking affects your gums and how you heal after an extraction or implant placement.

Medicines and allergies

Some medicines change the way we work, so it is important that we know about them in advance.

Do you take blood thinners (for example warfarin, aspirin or newer anticoagulants)?

If so, we agree on steps to prevent bleeding before extractions and other procedures.

Have you ever taken medicines for osteoporosis or to strengthen your bones, as tablets, injections or infusions?

These medicines matter before tooth extractions and implant placement.

Are you allergic to any of the following?
Have you ever felt unwell after a dental anaesthetic (for example fainting or a racing heart)?

If so, we choose a different anaesthetic and work more slowly.

Your teeth and reason for visiting
Why are you coming in?
If something hurts, how bad is it? (0 – no pain, 10 – worst pain)
When did you last see a dentist?
Do your gums bleed when you brush your teeth?
Do you clench or grind your teeth, during the day or at night?

If you're not sure: signs include someone telling you that you grind in your sleep, or waking up with a tight jaw.

Making it easier for you
How anxious are you about going to the dentist? (0 – not at all, 10 – very)

The more we know, the easier it is to adjust the pace, breaks and explanations.

Which language would you like us to speak?
How would you like to be reminded about your check-up?