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讓你重拾笑容

讓我們為你提供治療

香港大學「笑容無界限」幼兒蛀牙治療計劃

HKU Dentistry "SmilesForAll" Early Childhood Caries Treatment Project 由胡忠家族慈善基金捐款支持 Supported by Wu Chung Family Charitable Foundation

性別 Gender
男 Male
女 Female

請提交以下資料 (只接受圖片檔)：

Please submit the following documents (images only accepted).

請如實填寫以下選項：

Please state the following facts truthfully.

申請人願意完成整個治療方案並配合治療時間安排。 The applicant is willing to comply with the entire treatment plan and schedule.
是 Yes
否 No
申請人健康狀況允許接受牙科治療，包括小型口腔手術。The applicant is medically fit to receive dental treatments, including minor oral surgeries.
是 Yes
否 No
申請人已仔細閱讀並了解「收集求診者個人資料聲明」(https://shorturl.at/fS1js)。The applicant has read through and understands the "Statement of Collection of Personal Information from Patients" (https://shorturl.at/fS1js).
是 Yes
否 No
申請人年齡介乎1至5歲並需接受蛀牙治療。The applicant is between 1-5 years old and suffering from dental caries.
是 Yes
否 No
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