Your dental history, in Chinese

Fill this in in English. It prints as a Chinese-English sheet you hand across the desk. Your dentist reads the Chinese column; you check the English one. This removes the single worst failure mode of dental treatment abroad — a doctor who does not know you are on blood thinners.

This never leaves your browser. There is no submit button on this page, no server receiving it, and no analytics attached to any of these fields. Your answers are held in this tab only and vanish when you close it. That is not a promise about our data policy — it is the reason there is no submit button.

Basics

Name as printed on your passport optional

Year of birth optional

Language you speak

What are you there for? Tick everything that applies.

Medical history Your dentist needs these before using anaesthetic or extracting anything.

Allergies This is the single most important box on the form.

Medications you take Blood thinners and bisphosphonates change how surgery is done.

Blood thinners (warfarin, aspirin, clopidogrel…)抗凝/抗血小板药物（华法林、阿司匹林、氯吡格雷等） Bisphosphonates (for bone density)双膦酸盐类药物（治疗骨质疏松） Insulin or diabetes medication胰岛素或降糖药 Blood pressure medication降压药 Steroids激素类药物 Immunosuppressants免疫抑制剂 None无

Questions you want to ask These print in Chinese so you can point at them.

Anything else Free text stays in English — I am not going to machine-translate your medical history and pretend it is accurate. Keep it short and use a translation app on the day for this part.