Clinic Staff Cyprus Travel & Smile Patient Stories Senses Press Contact Cosmetic Dentistry Oral Implantology Pediatric Dentistry Periodontology Endodontics Orthodontics Preventive Dentistry Travel & Smile Name Surname Birthday Age Address City Country Post Code Home # Email Work # Mobile # Who may we thank for telling you about our site? Reason of Visit in our site MEDICAL HISTORY HEART DISORDERS Heart Murmur Rheumatic Fever Hypertension Other BLOOD DISORDERS Anemia Thalassemia Hemophilia Blood Transfusion BREATHINGS OR LUNG DISORDERS Asthma Emphysema Tuberculosis MUSCLE / SKIN / BONE PROBLEMS Arthritis / Rheumatisms Other ENDOCRINE DISORDERS Diabetes Thyroid LYMPHATIC SYSTEM DISORDERS Tonsils Infection / Chronic Adenoid NERVOUS SYSTEM DISORDERS Epilepsy / Convulsions Developmental Delay Cerebral Palsy Hyperactivity - ADD / ADHD OTHERS Cancer Chemotherapy / Radiation Therapy AIDS / HIV Positive Hepatitis Allergies / Medicine Allergies DENTAL HISTORY GUMS Bleeding Sensitivity Redness Swelling Bad Breath DENTAL WORKS (EXISTING) Bridges Crowns Root Canal Treatments Filings Implants YOUR SMILE Gummy Smile (You show your gums when smiling) Bright Smile Narrow Smile TEETH Pain Caries Fractures Grinding Substances And Losses Sensitivity Missing Teeth   ESTHETICS Good Fair Bad Colour of teeth Shape of teeth Position of teeth DENTAL WORKS (NEEDED) Facings (Veneers) Bleeching Full - Ceramic Crowns Implants Child Dentistry Ceramic Inlays (Filings) MEDICATION AND HABITS Are you having any medical treatment or taking any medicines Doses Smoking How Many Drinking Nicosia Dental Polyclinic 5 KRETE STREET P.O.B. 2011 1060 NICOSIA CYPRUS DENTAL HISTORY Copyright © 2006 Nicosia Dental Polyclinic Terms & Conditions of Use and Privacy Policy Web-design by ArtFX