Affordable Dental Implants | Dental Implantology | Dental Tourism Kerala

online dental assessment

Name * : Address : Nationality * : Age  : Sex  : Male Female Telephone : E-mail * : Give a brief Description about your Dental Problems. Also designate the teeth with number as above: Eg: Upper Right central incisor is 11 Lower Rights first molar 46 Any Medical Problems : (Ex. Diabetes, Hypertension, etc..) Filled : Root canal done : Crowned : Missing : For Security Reasons Please Enter the characters shown below: * Change Image :

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Online Dental Assessment

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Quick Tips

1. When you fill this form the details you give will form the basis of assessment.


2. Please describe your dental problem in your own words.(Eg: I am missing five teeth in the back of my upper jaw on my right side)


3. Describing your medical problems will help us to modify the treatment to suit your medical conditions


4. Please mention the medication you are on as with some medications surgery has to be modified


5. Describing the cause of loosing teeth is helpful (Eg: gum infection, sports injury etc)


6. Mention for how long you are missing teeth. (If you are missing teeth for a long time then bone augmentation may be needed)


7. For us to contact you back the only means is by a valid email id. So please make sure to spell the email id correctly.(small letters, spaces etc)


8. Assessment form is only the first step. Series of email will follow between us until everything is finalized.


9. The tooth numbering chart will help you designate the correct tooth number


10. The security code at the end of the form is for preventing software generated junk mail.


11. Our center is located in southern most tip of India, State of Kerala. Please understand the geography before you fill the assessment form.