Patient History

Welcome to the patient history section! Filling out this form is the critical first step in assessing your dental health and creating a personalized treatment plan. The information you provide helps us better understand your needs and ensure comprehensive, safe and effective care.

Why is the medical history important?

  • Thorough assessment of your health: To identify your current condition and potential risks.
  • Dedicated and unique treatment: Every decision is based on your needs and personal history.
  • Maximum safety: Helps prevent any complications during treatment.

    -Name And Surname

    Email Address

    Phone Number

    Do you suffer from blood diseases?

    Do you suffer from hypertension?

    Heart surgeries?

    Cardiac problems?

    Rheumatic fever?

    Food allergies?

    Medications allergies?

    Allergy to metals/materials?

    Mental illnesses / Antidepressants?

    Do you suffer from epilepsy?

    Drug use?

    Do you suffer from glaucoma?

    Do you suffer from diabetes?

    Treatment for cancer or radiation therapy?

    Bronchial asthma?

    Do you suffer from tuberculosis?

    Do you suffer from HIV/Hepatitis?

    Do you suffer from any illnesses? What medications are you currently taking?

    Contact Us

    +355686688888

    Copyright 2024 by Radiance.al All rights reserved.

    Copyright 2024 @Radiance.al . All rights reserved.

    bt_bb_section_top_section_coverage_image