Project: DESTINATION SMILE (HashyoKamal)

DESTINATION SMILE is a project aiming to raise public awareness of signs and symptoms of Oral cancer and habit intervention strategies for early detection and prevention of Oral cancer.

Please fill up your suitable form A/B/C so that we can contact you. Thanks in advance.

A. Dentists, Dental interns and House staffs, Dental Students:

Name:
Age:
Institute or Practice Name:
E-mail:
Phone:
-

B. Medical Professionals:

Name:
Age:
Institute/ Practice Name:
E-mail:
Phone:
-

C. Report Submission:

No of patients screened:
Age Group:
Date:
 / 
 / 
No of cases Pre-malignant lesion:
No of cases Malignant lesion:
E-mail:
Phone (screening institution):
-

Color Skin

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