Step 1 - Clinic Background
Questions and answers feature for members/one-time users, with check box entry via username and password
We hope to be able to address your expectations, so please tell us whatis your reason for contacting us? What answers are you hoping to receive from us? If you are the patient or a parent: Have you been referred by a dentist or orthodontist? Yes No Have you consulted an orthodontist or received advice? Yes No Please give name and e-mail address of orthodontist if any: Name E-mail address
Questions for all applicants: Please give patient's age and sex male female Please give background of patient's general health Medical history - give details: Present medical condition - give details: Has the patient been advised that he/she needs antibiotic cover fordental treatment? Yes No Please note all medicines taken on a regular basis Does the patient take bisphosphonate drugs (for osteoporosis etc) on a regular basis? Yes No Does the patient have any allergies?
Please assess the level of oral hygiene maintenance Please give an assessment of the general health of the teeth and gums Please list teeth with large restorations, root canal treatments and teeth with poor prognosis. Please send any radiographs as attachments to the following e-mail: adrian.becker@mail.huji.ac.il Do not arbitrarily perform further radiographs before being advised to do so. Please also send intra-oral photographs of the teeth in occlusion, occlusal and full face views as attachments.
Do you have any specific question that this questionnaire has notaddressed? If you have a problem with this questionnaireplease email to adrian.becker@mail.huji.ac.il
Step 2 - Payment
The charge for the initial consultation and e-mailed reply with a general assessment on the basis of the material presented, will be US$150 (VAT will only be applied where legally required). A definitive plan for recommended treatment may require additional records (radiographs, CBCT etc), in which case these will be listed. Completion of the consultation with a diagnosis and suggested treatment plan, following submission of these additional records may incur a further fee, in which case this will be stated in the initial e-mailed reply.
* I wish to pay for initial advice for this case only - cost US$150 (VAT will only be applied where legally required)
First name Family name Email * Address City Postal code State Country
Disclaimer: The advice and recommendations given here must be viewed with caution as they are based only on the information provided without the possibility of a thorough clinical examination by Dr. Becker and in the absence of any other possibly relevant information. They are intended only as an aid in diagnosis and treatment planning and are for the practitioner to take into consideration before deciding upon a definitive treatment plan, for the outcome of which he/she alone will be fully responsible. * I have read the disclaimer