Smiles Turkey Client Referrals

CLIENT DETAILS

Are you currently suffering from any disease such as, Heart issues, Diabetes, High Cholesterol, High Blood pressure? *
Are you currently taking and medications or vitamins? *
Do you have any allergies such as Penicillin ect? *
Are you taking Aspirin or another medication that speeds up blood flow? *
Have you had any form of major surgery within the last 10 years? *
Are you allergic to any metals? *
Are you able to provide any current dental X Rays? *
Are you a smoker? *