• info@zahnzentrum-mitte.de
  • 030 3913750


Please complete the following form as fully as possible and press send. If you do not want to answer a question or do not understand it you can just leave it out. Filling in the medical history form is important for us to be able to treat you in the best possible way and serves as preparation for you and the dentist for the joint consultation or treatment. If you have difficulties filling out this form yourself, a relative can do this for you. All information is subject to medical confidentiality.
Thank you very much!

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    Your personal health check

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    Special offers

    offers (e.g. bleaching, prophylaxis, etc.)?