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3 clinics in Kiev
in the central regions
from 9:00 to 21:00 seven days a week

Anamnestic questionnaire

Child’s full name
Date of Birth
Sex
Telephone number
Full name of the parent or guardian
Date of the last doctor’s visit or any medical treatment
Does the child have any dental pain or any urgent matter requiring treatment?

Has the child had any injuries in the mouth or tooth area (from falls or blows)?

Is this the first visit to the dentist?

Are there any physical development problems?

Has the child ever had convulsions, loss of consciousness or fainting?

Does the child have any congenital heart problem that has not been treated?

Has the child ever had a blood transfusion?

Do bruises appear easily? Does the child have nose bleeding or severe hemorrhaging from small wounds?

Does the child suffer of upper respiratory tract infections? If yes, how frequently: less than 4 times/year, 4 times/year, more than 4 times/year
Does the child have diabetes mellitus?

Does the child have thyroid decease or any other gland problems? If so, please indicate which.

Are there any skin deceases?

Are there any allergic reactions to medication? If yes, which ones?

Has the child ever had an adverse reaction to anesthetics? If yes, which ones?

Are there any food allergies? If yes, to which food products?

Are there any other allergies? Please indicate which ones.

Has the child ever had urticaria (hives), allergic fever or skin rashes?

Is the child currently taking any medication (with or without medical prescription). If yes, please indicate which one(s), dosage and for how long?
Has the child been vaccinated against diphtheria, pertussis, tetanus, polio, parotitis, varicella, hepatitis B, rubella (German measles)? Indicate any other vaccine.
Is the child currently ill?

Has the child been ill recently? How long ago?

Please underline if the child has had any of the following deceases; indicate the year it happened: varicella, measles, infectious mononucleosis, rubeola, scarlet fever, parotitis, tuberculosis, otitis, conjunctivitis UPTI (upper respiratory tract infections): faringitis, rhinitis, sinuses ,tonsilitis Drug abuse, addiction to sedatives, alcoholism HIV /AIDS
How frequently does the child brush his/her teeth?
Does anyone assist the child in brushing his/her teeth?

Does anyone check the thoroughness of these procedures?

What toothpaste does the child use?

Has the child had fluorine treatment?

Has the child had fluorine treatment?

Has the child taken fluorine in tablets or with vitamins?

What is the source of your drinking water? Please underline: faucet, private supply; filtered.
How did you hear about our dental clinic?

Avanto (Center) Dental Clinic

стоматология в киеве центр

1. By Metro – Palace Ukraine, walk to the side of Predslavynska St., left turn into Novopecherskyi Lane. The clinic is placed in Prestige Hall residential complex, the entrance is from the side of Vasyl Tyutyunnik St.
2. By car – you can get to the central entrance to the clinic from Ionna Pavla II St. (the former – Patrisa Lumumby St.), turn into Vasyl Tyutyunnik St.

Avanto (Podil) Dental Clinic

киев стоматология подольский район

1. By Metro – Kontraktova Ploshcha, walk on the street Kostiantynivska towards “Zhovten” cinema. The entrance to “cinematographic” arche.
2. By car – you can get to the central entrance of the clinic from Kostiantynivska St. through “cinematographic” arche. It is also possible to park a car in the parking lot near the square on the street Yaroslavska.

Avanto (Pechersk) Dental Clinic

киев стоматология печерский район

1. By Metro – Pecherska, walk on the street Lasya Ukrainka to the side of The Ivan Bohun Military High School. The building where the clinic is placed is located behind the CEC building and has a wave-shaped roof.
2. By car – the first arrival to the central entrance of the clinic is possible from Lesya Ukrainka St. behind The Ivan Bohun Military High School. Also it is possible to get there from the side of Staronavodnytska St., the turn is near the pointer of TSARSKY sport club. The building where the clinic is placed has a wave-shaped roof.