About the Condition and Treatment
To help us understand that this treatment is the right option for you, please answer the following questions. If you get stuck or need any help, you can contact us.
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Have you undergone a tooth decay, enamel demineralization, or tooth wear examination by your dentist in the last 6 months?
Can you relate to any of the following?
You have an underlying medical condition
Can you relate to any of the following?
Your hair loss started recently, and you've lost a lot of hair in less than four weeks.
Hair loss has occurred in irregular spots on your head.
Your scalp is itchy or inflamed.
You've lost your hair as a result of your pharmacological treatment.
You're completely bald or have lost all of your body hair.
Are you currently receiving any treatment or under any medication?
Please provide more information of the medication being used if any.
If female or transmale, are you currently pregnant, breastfeeding or planning to do so?
Please select your option
What is your biological gender?
Please select your option
Do you experience sensitivity to fluoride or any of the other components in toothpaste?
Have you used any other fluoride-containing products, such as mouthwash, for the same purpose lately?
Do you have a history of using Colgate® Duraphat®?
Are you on any medications that cause you to have dry mouth?
If you do, please explain which drug is causing these side effects and how serious they are.
Are there any wounds, injuries or open cuts in your mouth?
Do any of the following symptoms apply to you:
Toothache
Do you visit your dentist every six months for a checkup?
Can we share this information with your General practitioner?
Providing us with your physician's address means that you allow us to share this information with him/her for updated medical records if need be. It also allows our clinician to access your medical records if there is a need for that. We advice you share this treatment with your doctor for him/her to update your medical records.
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