Arouca Dental Clinic
#19 Eastern Main Road, Arouca
Tel: 692-4753/4
Dr. Misha Mohammed-Nagassar D.D.S.
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Civil Status: Married
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Medical History
Have You ever had :
Rheumatic Fever
Any Heart Problems
Blood Pressure Problem
Blood Sugar (Diabetes)
Does anyone in the family have Diabetes
Bleeding Disorders
Any Allergies or bad reaction to any Medication
Jaundice or Hepatitis
Kidney Problems
Arthritis
Any Joints Replaced
Any Fainting Attacks
Any Epileptic Attacks
Any Chest/Asthma Problems
Anaemia or Sickle Cell trait
Tuberculosis (TB)
Stroke (C.V.A)
Thyroid Disease or Goitre
Headaches
Any Veneral Diseases
Any Previous Cancer
Do you have any reason to believe you may have come in contact with the AIDS virus?
Do you Smoke?
Are you presently being treated by a physician for any condition?
Ladies do you think you might be Pregnant?
Are you taking pills, tablets or medication?
Is there any further information you think might be relevent to dental treatment?
Dental History
T.M.J
Lips
Buccal Mucosa
Vestibules
Oropharynx
Palate
Tongue
Floor Mouth
Salivary ducts and glands
18
17
16
15
14
13
12
11
21
22
23
24
25
26
27
28
55
54
53
52
51
61
62
63
64
65
85
84
83
82
81
71
72
73
74
75
48
47
46
45
44
43
42
41
31
32
33
34
35
36
37
38
Dental Notes
Legend
message here
Dec 2025
Jan 2026
Mar 2026
Mar 2026
May 2026
May 2026
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
Sun 30 Nov 2025
Time
Appointments
8:00 AM
8:30 AM
9:00 AM
9:30 AM
10:00 AM
10:30 AM
11:00 AM
11:30 AM
12:00 PM
12:30 PM
1:00 PM
1:30 PM
2:00 PM
2:30 PM
3:00 PM
3:30 PM
4:00 PM
