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