/Patient Query Form
Patient Query Form 2019-11-16T04:48:41+00:00

    Name of the patient
    Nationality of the Patient
    Sex malefemale
    Land line number
    Mobile number
    Give a brief Description about your Dental Problems. Also designate the teeth with number as above. Eg: Upper Right central incisor is 11
    Lower Rights first molar 46
    Any Medical Problems
    (Ex. Diabetes, Hypertension, etc..)
    Fillings done in teeth.
    Root canal treatment done in any tooth.
    Crown or Bridges on your teeth.
    Missing teeth if any.