Please complete all required fields accurately for the best care experience.
Personal Information
First name is required
Last name is required
Date of birth is required
Valid phone number required
Visit Information
Visit type is required
Preferred date is required
Chief Complaint & Symptoms
Toothache
Gum Bleeding
Sensitivity
Cavity / Decay
Broken Tooth
Missing Tooth
Orthodontic
Cosmetic
Wisdom Tooth Pain
🌿 Bad Breath
🌿 Multiple Tooth Decay
🌿 Oral Hygiene Guidance
🌿 Tobacco / Smoking Use
🌿 Preventive Care / Checkup
🌿 General Screening
🌿 Child Dental Issues
🌿 Community / Camp Visit
Other
🏥 This concern will be routed to Public Health Dentistry for preventive care, screening, and oral health education.
Please select a concern
No painMildModerateSevereUnbearable
— Upper Jaw —
— Lower Jaw —
FDI World Dental Federation - tooth numbering system
Upload an existing X-ray (optional) — our AI will analyse it and improve diagnosis accuracy.
Accepted: JPG, PNG, DICOM · Max 15 MB
🦷
Click to upload or drag & drop your X-ray here
Your X-ray is processed securely and never shared without consent
📷
—
—
🏥 Lifestyle & Risk Factors
Public Health Screening
Select any that apply — helps us route you to the right preventive care program.
🚬 Tobacco / Smoking
🍃 Pan / Gutka Use
🍭 High Sugar Diet
🍺 Alcohol Use
🪥 Poor Oral Hygiene
📅 No Regular Dental Visits
👶 Child with Oral Habits
🏘️ Rural / Outreach Patient
Medical History
Diabetes
Hypertension
Heart Disease
Bleeding Disorder
Asthma
Kidney Disease
Thyroid
None
No
Yes – Pregnant
Yes – Breastfeeding
Not Applicable
Emergency Contact
By proceeding, you consent to NMS Dental Care collecting and processing your information for treatment purposes in accordance with HIPAA and applicable data protection laws.
🔒 Privacy & Consent
HIPAA Compliant
Notice of Privacy Practices Required
I acknowledge that NMS Dental Care collects my personal and medical information solely for treatment, payment, and healthcare operations as permitted under HIPAA. I understand I have the right to access, amend, and restrict use of my information.
AI Clinical Decision Support Required
I consent to NMS Dental AI analysing my symptoms using an automated rule-based system to suggest a dental specialty. This is a decision-support tool only and does not replace a licensed dentist's clinical judgement.
Treatment Consent Required
I consent to examination and treatment by NMS Dental Care clinicians. I understand any treatment plan will be discussed with me before any procedure is performed.
X-ray AI Analysis Optional
I consent to my uploaded X-ray being analysed by NMS AI software for preliminary findings. All results will be reviewed by a licensed dentist before any clinical decision is made.
Electronic Health Record Sharing Optional
I consent to my dental records being shared with authorised EHR systems (Open Dental / Dentrix) for continuity of care. Only minimum necessary information will be shared.
⚠️ Please accept all required consent items to continue.
Step 1 of 3
Step 2 of 3
AI / ML Analysis & Doctor Specialty
Our AI engine analyses your symptoms to recommend the most appropriate specialist.
NMS AI Engine — Analysis Complete
Symptom Analysis Results
Primary Diagnosis Flag
—
—
Confidence Score
—
Based on symptom pattern matching
Urgency Level
—
—
Recommended Specialty
—
AI-suggested specialist
🦷 X-ray AI Findings
Radiograph Analysis
Select Doctor Specialty
🦷
Endodontist
Root canal, pulp therapy & tooth pain
🩺
Periodontist
Gum disease & supportive tissue
😁
Orthodontist
Braces, aligners & bite correction
⚕️
Oral Surgeon
Extractions, implants & jaw surgery
🔬
Prosthodontist
Crowns, bridges & dentures
📋
General Dentist
Checkups, cleanings & fillings
👶
Pediatric Dentist
Child dental care & habit counselling
🔭
Oral Pathologist
Lesions, patches & oral cancer screening
🏥
Public Health Dentistry
Prevention, screening & community oral health
Please select a specialty
Choose Your Doctor
Select a specialty above to see available doctors.
Please select a doctor
Available Time Slots
Please select a time slot
Additional Notes
Step 2 of 3
Step 3 of 3
Appointment Summary & Confirmation
Please review all details carefully before confirming your booking.
All Details Verified
Your intake form is complete. Confirm below to book your appointment.
Reference: —
Appointment Preview
—
NMS Dental Care, Hyderabad, INDIA
—
Patient Information
Full Name—
Date of Birth—
Phone—
Visit Type—
Risk Factors—
Chief Complaint
Primary Concern—
Pain Level—
Duration—
Affected Teeth—
AI Analysis
Diagnosis Flag—
Confidence—
Urgency—
Suggested Specialty—
Appointment Details
Doctor—
Specialty—
Time Slot—
StatusPending Confirmation
Our team will call you within 30 minutes to confirm your appointment. An SMS confirmation will also be sent.
Appointment Confirmed!
Your intake form has been submitted and your appointment is scheduled at NMS Dental Care.
Booking Reference
—
An SMS confirmation has been sent to your registered mobile number.