New patient

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    Please tick the boxes that apply to you...

    You have had orthodontic treatment

    You have had teeth extracted

    You have had damage to the teeth or jaw fractures

    You suffer from headaches

    You have pain in your jaws, or your jaws are making noise

    You have had otitis (middle ear infection)

    You have had adenoids removed

    You have had your tonsils removed

    You have hay fever

    You have other allergies

    der er paradontose

    You have periodontitis

    You have had treatment for periodontitis

    You can not tolerate local anaesthesia

    You are allergic to penicillin

    You suffer from general disorders

    You take medicine

    Why do you seek orthodontic treatment?

    I want to approve my appearance

    I feel my teeth are incorrectly positioned

    I have problems with chewing or biting

    Other reasons