Whise Smile Dental Clinic

{{-- HEADER --}} @include('partials.adminHeader') {{-- SIDE NAVIGATION BAR --}}

× Dashboard Appointments Patient's Record Reports Maintenance Inventory Help About Logout

EDIT PATIENT RECORD

ADMIN

@csrf @method('PUT')

Last Name

First Name

Middle Name

Suffix

Date of Birth

Gender
gender === 'Male' ? 'checked' : '' }}> Male
gender === 'Female' ? 'checked' : '' }}> Female
gender === 'Other' ? 'checked' : '' }}> Other

Marital Status

Home Address

Contact Number

Email Address

Last Dentist Visit

Dental History

Had Cavities?
had_cavities === 'Yes' ? 'checked' : '' }}> Yes
had_cavities === 'No' ? 'checked' : '' }}> No

Have Tooth Sensitivity?
have_tooth_sensitivity === 'Yes' ? 'checked' : '' }}> Yes
have_tooth_sensitivity === 'No' ? 'checked' : '' }}> No

Grind or Clench Teeth?
grind_or_clench_teeth === 'Yes' ? 'checked' : '' }}> Yes
grind_or_clench_teeth === 'No' ? 'checked' : '' }}> No

Had Oral Surgeries?
had_oral_surgeries === 'Yes' ? 'checked' : '' }}> Yes
had_oral_surgeries === 'No' ? 'checked' : '' }}> No

Had Braces or Orthodontic Treatments?
had_braces_or_orthodontic_treatments === 'Yes' ? 'checked' : '' }}> Yes
had_braces_or_orthodontic_treatments === 'No' ? 'checked' : '' }}> No

Have Gum Disease?
have_gum_disease === 'Yes' ? 'checked' : '' }}> Yes
have_gum_disease === 'No' ? 'checked' : '' }}> No

Do Gums Bleed?
do_gums_bleed === 'Yes' ? 'checked' : '' }}> Yes
do_gums_bleed === 'No' ? 'checked' : '' }}> No

Gum Recession or Gum Grafting?
gum_recession_or_gum_grafting === 'Yes' ? 'checked' : '' }}> Yes
gum_recession_or_gum_grafting === 'No' ? 'checked' : '' }}> No

Lost Teeth Due to Decay or Injury?
lost_teeth_due_to_decay_or_injury === 'Yes' ? 'checked' : '' }}> Yes
lost_teeth_due_to_decay_or_injury === 'No' ? 'checked' : '' }}> No

Have Dental Implants?
have_dental_implants === 'Yes' ? 'checked' : '' }}> Yes
have_dental_implants === 'No' ? 'checked' : '' }}> No

Have Crowns, Bridges, or Dentures?
have_crowns_bridges_or_dentures === 'Yes' ? 'checked' : '' }}> Yes
have_crowns_bridges_or_dentures === 'No' ? 'checked' : '' }}> No

Brush Teeth at Least Twice a Day?
brush_teeth_at_least_twice_a_day === 'Yes' ? 'checked' : '' }}> Yes
brush_teeth_at_least_twice_a_day === 'No' ? 'checked' : '' }}> No

Floss Daily?
floss_daily === 'Yes' ? 'checked' : '' }}> Yes
floss_daily === 'No' ? 'checked' : '' }}> No

Taking Medications?
taking_medications === 'Yes' ? 'checked' : '' }}> Yes
taking_medications === 'No' ? 'checked' : '' }}> No

Consume Sugary or Acidic Foods?
consume_sugary_or_acidic_foods === 'Yes' ? 'checked' : '' }}> Yes
consume_sugary_or_acidic_foods === 'No' ? 'checked' : '' }}> No

Is Smoking?
is_smoking === 'Yes' ? 'checked' : '' }}> Yes
is_smoking === 'No' ? 'checked' : '' }}> No

Drink Coffee, Tea, or Red Wine?
drink_coffee_tea_or_red_wine === 'Yes' ? 'checked' : '' }}> Yes
drink_coffee_tea_or_red_wine === 'No' ? 'checked' : '' }}> No

Medical Conditions

Allergy

Username

User ID