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Children's health questionnaire

1Your child's information

2Dental questions

3Medical history

4Medication and wishes

5Agree and send

Name(Required)

First Last

E-mail address(Required)

Telephone(Required)

Gender(Required)

Date of birth(Required)

BSN Number

Health insurance policy number

Has your child had cavities in the past 2 years?(Required)

Are any teeth sensitive when eating or drinking or brushing your teeth?(Required)

Are there any details regarding the change of baby teeth?(Required)

Does your child go to the orthodontist?(Required)

Has your child ever fallen on the front teeth or chin?(Required)

Is your child allergic to anything?(Required)

What is your child allergic to?

Has your child been breastfed?(Required)

Was your child born with a heart defect?(Required)

Does your child suffer from epilepsy?(Required)

Does your child have asthma, COPD or chronic lung disease?(Required)

Does your child have diabetes?(Required)

Does your child have anemia or anemia?(Required)

Does your child have hepatitis or other liver disease?(Required)

Does your child have kidney disease?(Required)

Does your child have problems with nutrition or gastrointestinal complaints?(Required)

Is your child anxious or hyperactive, or does your child have other behavioral problems?(Required)

Does your child attend special education or a medical day care center?(Required)

Is your child taking medication?(Required)

An overview of your medication(Required)

Indicate which medication you use, how often you use this medication and in what quantities

Are there other things we can take into account?(Required)

What can we take into account?

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Comments

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Google Rating

4.9

Based on 28 reviews

Dental Practice Leidschendam

4.9

15:26 15 Oct 24

Very satisfied with Magda as a dentist! Personal attention, knowledgeable and also a very beautiful and atmospheric practice. Recommended!

Angelika Leszczynska

19:01 29 Sep 24

Great dental clinic! Magdalena is very friendly and professional. She made me feel at ease and the treatment was quick and painless. Highly recommended!

Maciej Krzysztyński

12:37 24 Sep 24

Pojawiłem się tam nieumówiony, z bólem zęba. I am very happy with the results after 24 hours, my doctor will tell you how to do it, and by the Pani Doctor. Świetny kontakt, empatia, no i chyba profesjonalizm (zobaczymy za 2 tygodnie), a na dodatek gra na fortepianie. Polecam

08:18 12 Jul 24

Very happy to go to this dentist! I have gotten rid of my fear and I am no longer afraid at all. Magdalena has helped me with a lot of patience over my fear of claustrophobia. And I am so happy because having a filling is now no longer a problem, fortunately. .She is very calm and nice and the atmosphere is very relaxed, and she really pays attention to the patient! Thank you, the whole family is very happy, and so am I!⭐⭐⭐⭐⭐

Richard Stoffels

10:53 05 Jul 24

When my dentist closed his own practice, I joined this dental practice last year. It is a beautiful practice on the water. As far as I have met her a few times now, Magdalena is a very skilled dentist and a very friendly person with genuine interest. I feel comfortable with her as my dentist. I am happy that I ended up at this dental practice. Dziękuję

Wojciech Zyczynski

12:58 27 May 24

Świetna profesjonalna obsługa. Polecam Doctor Magdę.

09:51 15 May 24

Professional dentist, who explains all the options calmly and clearly with the pros and cons. And especially with a friendly smile. Highly recommended!

07:27 29 Feb 24

Najlepszy dentysta u jakiego bylam.Polecam!

14:42 18 Jan 24

Great dentist, professional and very friendly!

20:39 17 Jan 24

I ended up at Magdalena through someone else, when my own dentist quit. It was a great experience and I am very happy. Magdalena explains everything really clearly and answers your questions clearly. She has time for you and she is also very cheerful. I sat relaxed in the chair, where I would normally be very nervous. I will definitely switch to this practice. Recommended.

14:51 04 Dec 23

A very friendly and skilled dentist in a well-organized small-scale practice. Takes the time for careful treatment.

Qwendolynn Van Der Wal

15:01 23 Oct 23

Beautiful small-scale dental practice. Very friendly and know how to deal with anxiety patients. I finally go to the dentist again with a good feeling and I really feel heard.

12:13 11 Aug 23

15:19 24 Jul 23

13:21 21 Jul 23

Beautiful practice with a friendly and good dentist. Everything was clearly explained and the treatment went well and painless. From now on my regular dental practice.

17:08 06 Jul 23

19:29 24 May 23

Jak najbardziej polecam, bardzo miła obsluga, podejscie do klienta fantastyczne. I bardzo dobrze zrobiona praca. Jeśli ktos naprawdę sie obawia to szczerze mówię nie ma czego. Polecam i pozdrawiam.

17:09 17 May 23

11:33 11 May 23

Tomáš Handlíř

12:06 05 Apr 23

The staff was professional, courteous and friendly. The dentist was always very informative, honest and caring. I would definitely recommend this clinic!

09:31 16 Mar 23

Had very nice treatment. Painless course, even though I am often afraid of going to the dentist. I was able to make a quick appointment and didn't have to wait.

3:15 PM 21 Feb 23

Very nice new practice with a great dentist who explains everything very well and seems very knowledgeable. Definitely recommended!

Kasia Trzebiatowska

11:05 09 Feb 23

Nelli Serzhanova

5:35 PM 18 Jan 23

I had a very nice experience at the clinic, very friendly and professional, definitely recommend!

Sebastian Schreijer

10:28 06 Jan 23

Magdalena is a very nice and knowledgeable dentist. Thinks along and provides both the simple (and less expensive) options and the extensive (and more expensive) options, so that you can make your own choice.

21:52 20 Oct 20

This dentist is really fantastic. Joana L. Bravo helped me with clear braces and provides excellent guidance. She explained exactly how everything works and continuously checks whether everything is going well. I am very satisfied with the very professional yet personal approach of this dentist. Her Portuguese training and way of disinfecting and sterilizing medical instruments also ensures greater safety than the average dentist in the Netherlands. An absolute must. This dentist is just great. Joana L. Bravo has helped me with my invisible braces and guides me perfectly in this process. She explained to me exactly how everything works and checks continuously if everything is still ok.I am very satisfied about the very professional but also personal approach of this dentist.Her Portuguese education and way of disinfecting and sterilizing the medical instruments provides a much greater safety than the average dentist in the Netherlands.Highly recommended.

Henriqueta Bravo

11:39 02 Jun 20

14:18 01 Jun 20

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