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Group-CS: Aesthetic

Dec 6 2023

Teeth Whitening

Explore more of our before & afters…

Teeth Whitening Read More »

Dec 6 2023

Internal Teeth Whitening 6

Explore more of our before & afters…

Internal Teeth Whitening 6 Read More »

Dec 6 2023

Edge composite bonding

CS: Composite Bonding, Group-CS: Aesthetic / By Prof Dr Christian Mehl / December 6, 2023 / 1 minute of reading

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Edge composite bonding Read More »

Dec 6 2023

Cosmetic Transformation

CS: Veneers, Group-CS: Aesthetic / By Prof Dr Christian Mehl / December 6, 2023 / 1 minute of reading

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Cosmetic Transformation Read More »

Dec 6 2023

Veneers upper jaw and bone correction

CS: Veneers, Group-CS: Aesthetic / By Prof Dr Christian Mehl / December 6, 2023 / 1 minute of reading

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Veneers upper jaw and bone correction Read More »

Dec 6 2023

Veneers

CS: Veneers, Group-CS: Aesthetic / By Prof Dr Christian Mehl / December 6, 2023 / 1 minute of reading

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Veneers Read More »

Dec 6 2023

Periodontal treatment and composite fillings

CS: Composite Bonding, Group-CS: Aesthetic / By Prof Dr Christian Mehl / December 6, 2023 / 1 minute of reading

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Periodontal treatment and composite fillings Read More »

Dec 6 2023

Removing decay/caries on posterior tooth

CS: Fillings, Group-CS: Aesthetic / By Prof Dr Christian Mehl / December 6, 2023 / 1 minute of reading

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Removing decay/caries on posterior tooth Read More »

Dec 6 2023

Fillings

CS: Fillings, Group-CS: Aesthetic / By Prof Dr Christian Mehl / December 6, 2023 / 1 minute of reading

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Fillings Read More »

Dec 6 2023

Aesthetic treatment with veneers

CS: Veneers, Group-CS: Aesthetic / By Prof Dr Christian Mehl / December 6, 2023 / 1 minute of reading

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Aesthetic treatment with veneers Read More »

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Dear Ladies and Gentlemen,

To help us provide safe, complication-free treatment and to comply with official regulations, we kindly ask you to share some important information with us. All details you provide will be kept strictly confidential in line with government data protection policies. If you experience any difficulties completing the form, please don’t hesitate to ask — we’ll be happy to assist you in person.

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Medical History

Have you recently been hospitalised (in the last 12 months)?(Required)

Yes

If yes, please share what for and how you we're treated please:

Do you have any underlying medical conditions we should be aware of?(Required)

Yes

If yes, please share what the medical conditions are please:

Name of your general practitioner (GP)

Are you taking any medication regularly at the moment?(Required)

Yes

If yes, what? Please list any medication below:

Please tick if you're taking any of the following medication:

Antidepressants (important if surgery is planned!)

Medication for Anticoagulation (e.g. Marcumar, Aspirin)

Painkillers

Bisphosphonates due to osteoporosis in the last years

Do you bleed longer than normal after injuries?(Required)

Yes

Have you ever had…

Any unusual reactions to injections or medication?(Required)

Yes

(e.g. iodine, penicillin etc.)

Asthma, hay fever or other allergies?(Required)

Yes

Heart or circulation diseases?(Required)

Yes

(e.g. Hyper-, Hypotonic, Endocarditic problems, replacement of the heart valves, infections)

Rheumatic diseases or pain in the joints?(Required)

Yes

Liver diseases?(Required)

Yes

(e.g. jaundice)

Diabetes?(Required)

Yes

Respiratory diseases?(Required)

Yes

Kidney diseases?(Required)

Yes

Infectious diseases?(Required)

Yes

(e.g. Tuberculosis, AIDS, HIV, Hepatitis, Gonorrhoea)

Do you suffer from insomnia or snoring?(Required)

Yes

Do you have problems with the thyroid?(Required)

Yes

Epileptic seizures?(Required)

Yes

Do you smoke?(Required)

Yes

If yes, how many per day?

Do you drink alcohol?(Required)

Yes

If yes, how many units a week?

Small glass of red/white/rosé wine (125ml, ABV 12%) – 1.5 units. Bottle of lager/beer/cider (330ml, ABV 5%) – 1.7 units. Can of lager/beer/cider (440ml, ABV 5.5%) – 2.4 units.

For female patients: Are you pregnant?(Required)

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Do you have an artificial hip?(Required)

Yes

Dental Health History

Do you currently have any issues with your teeth or oral health that immediately require the attention of a dentist?(Required)

Yes

If yes, where?

Do you have problems with your gums?(Required)

Yes

If yes, where?

Is your chewing ability reduced?(Required)

Yes

Are you happy/comfortable with the look of your teeth?(Required)

Yes

If no, what specifically do you not like/not comfortable with?

Do you suffer from any symptoms of TMJ? Or have you been diagnosed with TMJ?(Required)

Yes

TMJ problems can cause pain or tenderness around the jaw and ears, clicking or popping noises when opening and closing the mouth, and difficulty fully opening the jaw or episodes of locking. People often experience headaches, neck or shoulder tension, and may notice their bite feels uneven or has changed. In many cases, teeth grinding or clenching also leads to visible wear on the teeth.

Do you have chronic head-, neck- or shoulder problems?(Required)

Yes

The reason for your dental visit?

Are you interested in any of the below treatments?

Dental Hygiene

Gum Disease

Root Canal Treatment

Full mouth reconstruction

Therapy of the TMJ

Implants

Cosmetic Dentistry (e.g. veneers, teeth whitening)

Halitosis (Bad breath) etc.

Specialist care for nervous patients

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