-- https://www.phpmyadmin.net/
--

START TRANSACTION;



-- --------------------------------------------------------

--
-- Table structure for table `cdt_admin_access_logs`
--

CREATE TABLE `cdt_admin_access_logs` (
  `id` bigint UNSIGNED NOT NULL,
  `admin_id` int DEFAULT NULL,
  `role_id` int DEFAULT NULL,
  `username` varchar(255) COLLATE utf8mb4_unicode_ci DEFAULT NULL,
  `role_name` varchar(100) COLLATE utf8mb4_unicode_ci DEFAULT NULL,
  `ip_address` varchar(45) COLLATE utf8mb4_unicode_ci DEFAULT NULL,
  `accessed_at` timestamp NOT NULL DEFAULT CURRENT_TIMESTAMP,
  `country` varchar(255) COLLATE utf8mb4_unicode_ci DEFAULT NULL,
  `region` varchar(255) COLLATE utf8mb4_unicode_ci DEFAULT NULL,
  `city` varchar(255) COLLATE utf8mb4_unicode_ci DEFAULT NULL,
  `continent` varchar(255) COLLATE utf8mb4_unicode_ci DEFAULT NULL,
  `timezone` varchar(255) COLLATE utf8mb4_unicode_ci DEFAULT NULL,
  `latitude` varchar(255) COLLATE utf8mb4_unicode_ci DEFAULT NULL,
  `longitude` varchar(255) COLLATE utf8mb4_unicode_ci DEFAULT NULL,
  `operating_system` varchar(255) COLLATE utf8mb4_unicode_ci DEFAULT NULL,
  `browser` varchar(255) COLLATE utf8mb4_unicode_ci DEFAULT NULL,
  `hostname` varchar(255) COLLATE utf8mb4_unicode_ci DEFAULT NULL,
  `screen_resolution` varchar(255) COLLATE utf8mb4_unicode_ci DEFAULT NULL,
  `access_method` varchar(255) COLLATE utf8mb4_unicode_ci DEFAULT NULL,
  `http_method` varchar(10) COLLATE utf8mb4_unicode_ci DEFAULT NULL,
  `route_name` varchar(255) COLLATE utf8mb4_unicode_ci DEFAULT NULL,
  `url` varchar(1024) COLLATE utf8mb4_unicode_ci DEFAULT NULL,
  `created_at` timestamp NULL DEFAULT NULL,
  `updated_at` timestamp NULL DEFAULT NULL
) ENGINE=InnoDB DEFAULT CHARSET=utf8mb4 COLLATE=utf8mb4_unicode_ci;

-- --------------------------------------------------------

--
-- Table structure for table `cdt_admin_role`
--

CREATE TABLE `cdt_admin_role` (
  `role_id` int UNSIGNED NOT NULL,
  `title` varchar(100) COLLATE utf8mb4_unicode_ci NOT NULL,
  `created_id` int NOT NULL DEFAULT '0',
  `updated_id` int NOT NULL DEFAULT '0',
  `created_at` timestamp NULL DEFAULT NULL,
  `updated_at` timestamp NULL DEFAULT NULL
) ENGINE=InnoDB DEFAULT CHARSET=utf8mb4 COLLATE=utf8mb4_unicode_ci;

--
-- Dumping data for table `cdt_admin_role`
--

INSERT INTO `cdt_admin_role` (`role_id`, `title`, `created_id`, `updated_id`, `created_at`, `updated_at`) VALUES
(1, 'Super Administrator', 1, 1, '2026-05-01 02:01:42', '2026-05-01 02:01:42');

-- --------------------------------------------------------

--
-- Table structure for table `cdt_clinics`
--

CREATE TABLE `cdt_clinics` (
  `clinic_id` int UNSIGNED NOT NULL,
  `title` varchar(255) COLLATE utf8mb4_unicode_ci NOT NULL,
  `slug` varchar(255) COLLATE utf8mb4_unicode_ci NOT NULL,
  `address` text COLLATE utf8mb4_unicode_ci,
  `phone` varchar(20) COLLATE utf8mb4_unicode_ci DEFAULT NULL,
  `email` varchar(128) COLLATE utf8mb4_unicode_ci DEFAULT NULL,
  `to_emails` text COLLATE utf8mb4_unicode_ci,
  `note` varchar(255) COLLATE utf8mb4_unicode_ci DEFAULT NULL,
  `c_order` int NOT NULL DEFAULT '0',
  `status` enum('enabled','disabled') COLLATE utf8mb4_unicode_ci NOT NULL DEFAULT 'enabled',
  `created_id` int NOT NULL DEFAULT '0',
  `updated_id` int NOT NULL DEFAULT '0',
  `created_at` timestamp NULL DEFAULT NULL,
  `updated_at` timestamp NULL DEFAULT NULL
) ENGINE=InnoDB DEFAULT CHARSET=utf8mb4 COLLATE=utf8mb4_unicode_ci;

--
-- Dumping data for table `cdt_clinics`
--

INSERT INTO `cdt_clinics` (`clinic_id`, `title`, `slug`, `address`, `phone`, `email`, `to_emails`, `note`, `c_order`, `status`, `created_id`, `updated_id`, `created_at`, `updated_at`) VALUES
(1, 'Oakville', 'oakville', '231 Oak Park Blvd., Suite #108,\nOakville, ON L6H 7S8', '905-257-2221', 'testing@tastechnologies.com', NULL, NULL, 1, 'enabled', 1, 1, '2026-05-01 08:02:28', '2026-05-01 13:10:21'),
(2, 'Burlington', 'burlington', '2455 Appleby Line, Suite #C08, \nBurlington, ON L7L 0B6', '905-336-0600', 'testing@tastechnologies.com', NULL, NULL, 2, 'enabled', 1, 1, '2026-05-01 08:03:12', '2026-05-01 13:10:28'),
(3, 'Mississauga', 'mississauga', '3427 Derry Rd East, Suite #201,\r\nMississauga, ON L4T 4H7', '905-672-2244', 'testing@tastechnologies.com', NULL, NULL, 3, 'enabled', 1, 1, '2026-05-01 08:04:02', '2026-05-01 13:10:34');

-- --------------------------------------------------------

--
-- Table structure for table `cdt_custom_field`
--

CREATE TABLE `cdt_custom_field` (
  `custom_field_id` int UNSIGNED NOT NULL,
  `field_name` varchar(128) COLLATE utf8mb4_unicode_ci NOT NULL,
  `label` varchar(128) COLLATE utf8mb4_unicode_ci NOT NULL,
  `type` enum('text','textarea','editor','image','file','dropdown','checkbox','radio_button') COLLATE utf8mb4_unicode_ci NOT NULL,
  `options_label` text COLLATE utf8mb4_unicode_ci COMMENT 'Stores labels in ARRAY format.',
  `options_value` text COLLATE utf8mb4_unicode_ci COMMENT 'Stores values in ARRAY format.',
  `field_placeholder` varchar(128) COLLATE utf8mb4_unicode_ci DEFAULT NULL,
  `field_information` text COLLATE utf8mb4_unicode_ci,
  `note` varchar(255) COLLATE utf8mb4_unicode_ci DEFAULT NULL,
  `required` enum('false','true') COLLATE utf8mb4_unicode_ci NOT NULL DEFAULT 'false',
  `c_order` int NOT NULL DEFAULT '0',
  `status` enum('enabled','disabled') COLLATE utf8mb4_unicode_ci NOT NULL DEFAULT 'enabled',
  `created_id` int NOT NULL DEFAULT '0',
  `updated_id` int NOT NULL DEFAULT '0',
  `created_at` timestamp NULL DEFAULT NULL,
  `updated_at` timestamp NULL DEFAULT NULL
) ENGINE=InnoDB DEFAULT CHARSET=utf8mb4 COLLATE=utf8mb4_unicode_ci;

-- --------------------------------------------------------

--
-- Table structure for table `cdt_custom_field_group`
--

CREATE TABLE `cdt_custom_field_group` (
  `cf_group_id` int UNSIGNED NOT NULL,
  `group_name` varchar(128) COLLATE utf8mb4_unicode_ci NOT NULL,
  `c_order` int NOT NULL DEFAULT '0',
  `status` enum('enabled','disabled') COLLATE utf8mb4_unicode_ci NOT NULL DEFAULT 'enabled',
  `created_id` int NOT NULL DEFAULT '0',
  `updated_id` int NOT NULL DEFAULT '0',
  `created_at` timestamp NULL DEFAULT NULL,
  `updated_at` timestamp NULL DEFAULT NULL
) ENGINE=InnoDB DEFAULT CHARSET=utf8mb4 COLLATE=utf8mb4_unicode_ci;

-- --------------------------------------------------------

--
-- Table structure for table `cdt_custom_field_group_custom_field`
--

CREATE TABLE `cdt_custom_field_group_custom_field` (
  `cfgc_field_id` bigint UNSIGNED NOT NULL,
  `cf_group_id` int NOT NULL,
  `custom_field_id` int NOT NULL,
  `created_id` int NOT NULL DEFAULT '0',
  `updated_id` int NOT NULL DEFAULT '0',
  `created_at` timestamp NULL DEFAULT NULL,
  `updated_at` timestamp NULL DEFAULT NULL,
  `deleted_at` timestamp NULL DEFAULT NULL
) ENGINE=InnoDB DEFAULT CHARSET=utf8mb4 COLLATE=utf8mb4_unicode_ci;

-- --------------------------------------------------------

--
-- Table structure for table `cdt_custom_field_group_template`
--

CREATE TABLE `cdt_custom_field_group_template` (
  `cfg_template_id` bigint UNSIGNED NOT NULL,
  `cf_group_id` int NOT NULL,
  `template_id` int NOT NULL,
  `created_id` int NOT NULL DEFAULT '0',
  `updated_id` int NOT NULL DEFAULT '0',
  `created_at` timestamp NULL DEFAULT NULL,
  `updated_at` timestamp NULL DEFAULT NULL,
  `deleted_at` timestamp NULL DEFAULT NULL
) ENGINE=InnoDB DEFAULT CHARSET=utf8mb4 COLLATE=utf8mb4_unicode_ci;

-- --------------------------------------------------------

--
-- Table structure for table `cdt_custom_field_value`
--

CREATE TABLE `cdt_custom_field_value` (
  `cf_value_id` bigint UNSIGNED NOT NULL,
  `module_id` int NOT NULL,
  `template_id` int NOT NULL,
  `cf_group_id` int NOT NULL COMMENT 'int, ID of custom_field_group table',
  `custom_field_id` int NOT NULL,
  `record_id` int NOT NULL COMMENT 'int, ID of page/project/etc.',
  `value` longtext COLLATE utf8mb4_unicode_ci,
  `created_id` int NOT NULL DEFAULT '0',
  `updated_id` int NOT NULL DEFAULT '0',
  `created_at` timestamp NULL DEFAULT NULL,
  `updated_at` timestamp NULL DEFAULT NULL,
  `deleted_at` timestamp NULL DEFAULT NULL
) ENGINE=InnoDB DEFAULT CHARSET=utf8mb4 COLLATE=utf8mb4_unicode_ci;

-- --------------------------------------------------------

--
-- Table structure for table `cdt_email_template`
--

CREATE TABLE `cdt_email_template` (
  `et_id` int UNSIGNED NOT NULL,
  `template_name` varchar(255) COLLATE utf8mb4_unicode_ci NOT NULL,
  `subject` varchar(128) COLLATE utf8mb4_unicode_ci NOT NULL,
  `message_template_type` enum('Body','Full') COLLATE utf8mb4_unicode_ci NOT NULL DEFAULT 'Body',
  `message_template` longtext CHARACTER SET utf8mb4 COLLATE utf8mb4_unicode_ci NOT NULL,
  `from_name` varchar(128) COLLATE utf8mb4_unicode_ci DEFAULT NULL,
  `from_email` varchar(128) COLLATE utf8mb4_unicode_ci DEFAULT NULL,
  `to_emails` text COLLATE utf8mb4_unicode_ci,
  `cc_emails` text COLLATE utf8mb4_unicode_ci,
  `bcc_emails` text COLLATE utf8mb4_unicode_ci,
  `created_id` int NOT NULL DEFAULT '0',
  `updated_id` int NOT NULL DEFAULT '0',
  `created_at` timestamp NULL DEFAULT NULL,
  `updated_at` timestamp NULL DEFAULT NULL
) ENGINE=InnoDB DEFAULT CHARSET=utf8mb4 COLLATE=utf8mb4_unicode_ci;


INSERT INTO `cdt_email_template` (`et_id`, `template_name`, `subject`, `message_template_type`, `message_template`, `from_name`, `from_email`, `to_emails`, `cc_emails`, `bcc_emails`, `created_id`, `updated_id`, `created_at`, `updated_at`) VALUES
(8, 'Admin New Patient Registration Enquiry Form Data', 'New Patient Registration Enquiry - Chagger Dental', 'Full', '<!DOCTYPE html>\r\n<html>\r\n\r\n<head>\r\n    <meta charset=\"UTF-8\">\r\n    <title>Chagger Dental</title>\r\n</head>\r\n\r\n<body style=\"margin:0;padding:0;background:#e9ecef;font-family:Arial,Helvetica,sans-serif;\">\r\n    <table width=\"100%\" cellpadding=\"0\" cellspacing=\"0\" style=\"background:#e9ecef;padding:30px 0;\">\r\n        <tr>\r\n            <td align=\"center\">\r\n                <table width=\"850\" cellpadding=\"0\" cellspacing=\"0\"\r\n                    style=\"background:#ffffff;border-radius:16px;border:4px solid #2f5f9e;\">\r\n                    <tr>\r\n                        <td align=\"center\" style=\"padding:20px;\">\r\n                            <table width=\"100%\" cellpadding=\"0\" cellspacing=\"0\">\r\n                                <tr>\r\n                                    <td align=\"left\" style=\"vertical-align:top;\">\r\n                                        <img src=\"https://chaggerdental.com/themes/frontend/images/dental-logo.png\"\r\n                                            width=\"250\" alt=\"Chagger Dental\">\r\n                                    </td>\r\n                                    <td align=\"right\" style=\"vertical-align:top;\">\r\n                                        <h1\r\n                                            style=\"margin:0 0 5px 0;font-family:Arial,Helvetica,sans-serif;font-size:26px;font-weight:700;color:#001e49;letter-spacing:1px;\">\r\n                                            {{location_name}}</h1>\r\n                                        <p style=\"margin:0 0 5px 0;font-size:14px;color:#434750;\">{{location_address}}\r\n                                        </p>\r\n                                        <p style=\"margin:0 0 5px 0;font-size:14px;color:#434750;\">\r\n                                            <a href=\"mailto:{{location_email}}\"\r\n                                                style=\"color:#434750;text-decoration:none;\">{{location_email}}</a>\r\n                                        </p>\r\n                                        <p style=\"margin:0;font-size:14px;color:#434750;\">{{location_phone}}</p>\r\n                                    </td>\r\n                                </tr>\r\n                                <tr>\r\n                                    <td align=\"center\" colspan=\"2\">\r\n                                        <h2\r\n                                            style=\"margin:30px 0 5px 0;font-family:Arial,Helvetica,sans-serif;font-size:24px;font-weight:700;color:#001e49;letter-spacing:1px;\">\r\n                                            CHAGGER DENTAL PATIENT INFORMATION</h2>\r\n                                    </td>\r\n                                </tr>\r\n                                <tr>\r\n                                    <td align=\"center\" colspan=\"2\">\r\n                                        <p style=\"margin:0;font-size:13px;color:#4e6072;text-align:center;\">\r\n                                            Submitted: {{submitted_at}}\r\n                                        </p>\r\n                                    </td>\r\n                                </tr>\r\n                            </table>\r\n                        </td>\r\n                    </tr>\r\n\r\n                    <tr>\r\n                        <td style=\"padding:0 20px 30px 20px;\">\r\n                            <table width=\"100%\" cellpadding=\"0\" cellspacing=\"0\" style=\"border:1px solid #eae8e4;border-radius:8px;\">\r\n                                <tr><td style=\"background:#0e336a;padding:12px 14px;border-top-left-radius:8px;border-top-right-radius:8px;\"><h3 style=\"margin:0;font-family:Arial,Helvetica,sans-serif;font-size:12px;color:#ffffff;letter-spacing:1px;\">PATIENT PROFILE</h3></td></tr>\r\n                                <tr><td style=\"padding:20px;\"><table width=\"100%\" cellpadding=\"10\" cellspacing=\"0\">\r\n<tr>\r\n<td width=\"50%\" style=\"font-family:Arial,Helvetica,sans-serif;font-size:13px;color:#4e6072;letter-spacing:1px;vertical-align:top;\">\r\n<table width=\"100%\" cellpadding=\"0\" cellspacing=\"0\"><tr>\r\n<td width=\"42%\" style=\"font-family:Arial,Helvetica,sans-serif;font-size:13px;color:#4e6072;vertical-align:top;\">Title</td>\r\n<td width=\"58%\" style=\"font-family:Arial,Helvetica,sans-serif;font-size:13px;color:#001e49;font-weight:bold;vertical-align:top;\">{{title}}</td>\r\n</tr></table></td>\r\n<td width=\"50%\" style=\"font-family:Arial,Helvetica,sans-serif;font-size:13px;color:#4e6072;letter-spacing:1px;vertical-align:top;\">\r\n<table width=\"100%\" cellpadding=\"0\" cellspacing=\"0\"><tr>\r\n<td width=\"42%\" style=\"font-family:Arial,Helvetica,sans-serif;font-size:13px;color:#4e6072;vertical-align:top;\">Full Name</td>\r\n<td width=\"58%\" style=\"font-family:Arial,Helvetica,sans-serif;font-size:13px;color:#001e49;font-weight:bold;vertical-align:top;\">{{full_name}}</td>\r\n</tr></table></td>\r\n</tr>\r\n<tr>\r\n<td width=\"50%\" style=\"font-family:Arial,Helvetica,sans-serif;font-size:13px;color:#4e6072;letter-spacing:1px;vertical-align:top;\">\r\n<table width=\"100%\" cellpadding=\"0\" cellspacing=\"0\"><tr>\r\n<td width=\"42%\" style=\"font-family:Arial,Helvetica,sans-serif;font-size:13px;color:#4e6072;vertical-align:top;\">Age</td>\r\n<td width=\"58%\" style=\"font-family:Arial,Helvetica,sans-serif;font-size:13px;color:#001e49;font-weight:bold;vertical-align:top;\">{{age}}</td>\r\n</tr></table></td>\r\n<td width=\"50%\" style=\"font-family:Arial,Helvetica,sans-serif;font-size:13px;color:#4e6072;letter-spacing:1px;vertical-align:top;\">\r\n<table width=\"100%\" cellpadding=\"0\" cellspacing=\"0\"><tr>\r\n<td width=\"42%\" style=\"font-family:Arial,Helvetica,sans-serif;font-size:13px;color:#4e6072;vertical-align:top;\">Sex</td>\r\n<td width=\"58%\" style=\"font-family:Arial,Helvetica,sans-serif;font-size:13px;color:#001e49;font-weight:bold;vertical-align:top;\">{{sex}}</td>\r\n</tr></table></td>\r\n</tr>\r\n<tr>\r\n<td width=\"50%\" style=\"font-family:Arial,Helvetica,sans-serif;font-size:13px;color:#4e6072;letter-spacing:1px;vertical-align:top;\">\r\n<table width=\"100%\" cellpadding=\"0\" cellspacing=\"0\"><tr>\r\n<td width=\"42%\" style=\"font-family:Arial,Helvetica,sans-serif;font-size:13px;color:#4e6072;vertical-align:top;\">Marital Status</td>\r\n<td width=\"58%\" style=\"font-family:Arial,Helvetica,sans-serif;font-size:13px;color:#001e49;font-weight:bold;vertical-align:top;\">{{marital_status}}</td>\r\n</tr></table></td>\r\n<td width=\"50%\" style=\"font-family:Arial,Helvetica,sans-serif;font-size:13px;color:#4e6072;letter-spacing:1px;vertical-align:top;\">\r\n<table width=\"100%\" cellpadding=\"0\" cellspacing=\"0\"><tr>\r\n<td width=\"42%\" style=\"font-family:Arial,Helvetica,sans-serif;font-size:13px;color:#4e6072;vertical-align:top;\">Date of Birth</td>\r\n<td width=\"58%\" style=\"font-family:Arial,Helvetica,sans-serif;font-size:13px;color:#001e49;font-weight:bold;vertical-align:top;\">{{date_of_birth}}</td>\r\n</tr></table></td>\r\n</tr>\r\n<tr>\r\n<td colspan=\"2\" style=\"font-family:Arial,Helvetica,sans-serif;font-size:13px;color:#4e6072;letter-spacing:1px;vertical-align:top;\">\r\n<table width=\"100%\" cellpadding=\"0\" cellspacing=\"0\"><tr>\r\n<td width=\"20.5%\" style=\"font-family:Arial,Helvetica,sans-serif;font-size:13px;color:#4e6072;vertical-align:top;\">Street Address</td>\r\n<td width=\"79.5%\" style=\"font-family:Arial,Helvetica,sans-serif;font-size:13px;color:#001e49;font-weight:bold;vertical-align:top;\">{{street_address}}</td>\r\n</tr></table></td>\r\n</tr>\r\n<tr>\r\n<td width=\"50%\" style=\"font-family:Arial,Helvetica,sans-serif;font-size:13px;color:#4e6072;letter-spacing:1px;vertical-align:top;\">\r\n<table width=\"100%\" cellpadding=\"0\" cellspacing=\"0\"><tr>\r\n<td width=\"42%\" style=\"font-family:Arial,Helvetica,sans-serif;font-size:13px;color:#4e6072;vertical-align:top;\">City</td>\r\n<td width=\"58%\" style=\"font-family:Arial,Helvetica,sans-serif;font-size:13px;color:#001e49;font-weight:bold;vertical-align:top;\">{{city}}</td>\r\n</tr></table></td>\r\n<td width=\"50%\" style=\"font-family:Arial,Helvetica,sans-serif;font-size:13px;color:#4e6072;letter-spacing:1px;vertical-align:top;\">\r\n<table width=\"100%\" cellpadding=\"0\" cellspacing=\"0\"><tr>\r\n<td width=\"42%\" style=\"font-family:Arial,Helvetica,sans-serif;font-size:13px;color:#4e6072;vertical-align:top;\">Province / State</td>\r\n<td width=\"58%\" style=\"font-family:Arial,Helvetica,sans-serif;font-size:13px;color:#001e49;font-weight:bold;vertical-align:top;\">{{province}}</td>\r\n</tr></table></td>\r\n</tr>\r\n<tr>\r\n<td width=\"50%\" style=\"font-family:Arial,Helvetica,sans-serif;font-size:13px;color:#4e6072;letter-spacing:1px;vertical-align:top;\">\r\n<table width=\"100%\" cellpadding=\"0\" cellspacing=\"0\"><tr>\r\n<td width=\"42%\" style=\"font-family:Arial,Helvetica,sans-serif;font-size:13px;color:#4e6072;vertical-align:top;\">Postal Code</td>\r\n<td width=\"58%\" style=\"font-family:Arial,Helvetica,sans-serif;font-size:13px;color:#001e49;font-weight:bold;vertical-align:top;\">{{postal_code}}</td>\r\n</tr></table></td>\r\n<td width=\"50%\">&nbsp;</td>\r\n</tr>\r\n<tr>\r\n<td colspan=\"2\" style=\"font-family:Arial,Helvetica,sans-serif;font-size:13px;color:#4e6072;letter-spacing:1px;vertical-align:top;\">\r\n<table width=\"100%\" cellpadding=\"0\" cellspacing=\"0\"><tr>\r\n<td width=\"20.5%\" style=\"font-family:Arial,Helvetica,sans-serif;font-size:13px;color:#4e6072;vertical-align:top;\">Email Address</td>\r\n<td width=\"79.5%\" style=\"font-family:Arial,Helvetica,sans-serif;font-size:13px;color:#001e49;font-weight:bold;vertical-align:top;\"><a href=\"mailto:{{email_address}}\" style=\"color:#2f5f9e;\">{{email_address}}</a></td>\r\n</tr></table></td>\r\n</tr>\r\n<tr>\r\n<td width=\"50%\" style=\"font-family:Arial,Helvetica,sans-serif;font-size:13px;color:#4e6072;letter-spacing:1px;vertical-align:top;\">\r\n<table width=\"100%\" cellpadding=\"0\" cellspacing=\"0\"><tr>\r\n<td width=\"42%\" style=\"font-family:Arial,Helvetica,sans-serif;font-size:13px;color:#4e6072;vertical-align:top;\">Home Phone</td>\r\n<td width=\"58%\" style=\"font-family:Arial,Helvetica,sans-serif;font-size:13px;color:#001e49;font-weight:bold;vertical-align:top;\">{{home_phone}}</td>\r\n</tr></table></td>\r\n<td width=\"50%\" style=\"font-family:Arial,Helvetica,sans-serif;font-size:13px;color:#4e6072;letter-spacing:1px;vertical-align:top;\">\r\n<table width=\"100%\" cellpadding=\"0\" cellspacing=\"0\"><tr>\r\n<td width=\"42%\" style=\"font-family:Arial,Helvetica,sans-serif;font-size:13px;color:#4e6072;vertical-align:top;\">Cell Phone</td>\r\n<td width=\"58%\" style=\"font-family:Arial,Helvetica,sans-serif;font-size:13px;color:#001e49;font-weight:bold;vertical-align:top;\">{{cell_phone}}</td>\r\n</tr></table></td>\r\n</tr>\r\n<tr>\r\n<td width=\"50%\" style=\"font-family:Arial,Helvetica,sans-serif;font-size:13px;color:#4e6072;letter-spacing:1px;vertical-align:top;\">\r\n<table width=\"100%\" cellpadding=\"0\" cellspacing=\"0\"><tr>\r\n<td width=\"42%\" style=\"font-family:Arial,Helvetica,sans-serif;font-size:13px;color:#4e6072;vertical-align:top;\">Occupation</td>\r\n<td width=\"58%\" style=\"font-family:Arial,Helvetica,sans-serif;font-size:13px;color:#001e49;font-weight:bold;vertical-align:top;\">{{cccupation}}</td>\r\n</tr></table></td>\r\n<td width=\"50%\" style=\"font-family:Arial,Helvetica,sans-serif;font-size:13px;color:#4e6072;letter-spacing:1px;vertical-align:top;\">\r\n<table width=\"100%\" cellpadding=\"0\" cellspacing=\"0\"><tr>\r\n<td width=\"42%\" style=\"font-family:Arial,Helvetica,sans-serif;font-size:13px;color:#4e6072;vertical-align:top;\">Employed By</td>\r\n<td width=\"58%\" style=\"font-family:Arial,Helvetica,sans-serif;font-size:13px;color:#001e49;font-weight:bold;vertical-align:top;\">{{employed_by}}</td>\r\n</tr></table></td>\r\n</tr>\r\n</table></td></tr>\r\n                            </table>\r\n                        </td>\r\n                    </tr>\r\n\r\n                    <tr>\r\n                        <td style=\"padding:0 20px 30px 20px;\">\r\n                            <table width=\"100%\" cellpadding=\"0\" cellspacing=\"0\" style=\"border:1px solid #eae8e4;border-radius:8px;\">\r\n                                <tr><td style=\"background:#0e336a;padding:12px 14px;border-top-left-radius:8px;border-top-right-radius:8px;\"><h3 style=\"margin:0;font-family:Arial,Helvetica,sans-serif;font-size:12px;color:#ffffff;letter-spacing:1px;\">DENTAL INSURANCE &amp; CARE PROVIDERS</h3></td></tr>\r\n                                <tr><td style=\"padding:20px;\"><table width=\"100%\" cellpadding=\"10\" cellspacing=\"0\">\r\n<tr>\r\n<td width=\"50%\" style=\"font-family:Arial,Helvetica,sans-serif;font-size:13px;color:#4e6072;letter-spacing:1px;vertical-align:top;\">\r\n<table width=\"100%\" cellpadding=\"0\" cellspacing=\"0\"><tr>\r\n<td width=\"42%\" style=\"font-family:Arial,Helvetica,sans-serif;font-size:13px;color:#4e6072;vertical-align:top;\">Dental Insurance</td>\r\n<td width=\"58%\" style=\"font-family:Arial,Helvetica,sans-serif;font-size:13px;color:#001e49;font-weight:bold;vertical-align:top;\">{{dental_insurance}}</td>\r\n</tr></table></td>\r\n<td width=\"50%\" style=\"font-family:Arial,Helvetica,sans-serif;font-size:13px;color:#4e6072;letter-spacing:1px;vertical-align:top;\">\r\n<table width=\"100%\" cellpadding=\"0\" cellspacing=\"0\"><tr>\r\n<td width=\"42%\" style=\"font-family:Arial,Helvetica,sans-serif;font-size:13px;color:#4e6072;vertical-align:top;\">Insurance Company</td>\r\n<td width=\"58%\" style=\"font-family:Arial,Helvetica,sans-serif;font-size:13px;color:#001e49;font-weight:bold;vertical-align:top;\">{{insurance_company}}</td>\r\n</tr></table></td>\r\n</tr>\r\n<tr>\r\n<td width=\"50%\" style=\"font-family:Arial,Helvetica,sans-serif;font-size:13px;color:#4e6072;letter-spacing:1px;vertical-align:top;\">\r\n<table width=\"100%\" cellpadding=\"0\" cellspacing=\"0\"><tr>\r\n<td width=\"42%\" style=\"font-family:Arial,Helvetica,sans-serif;font-size:13px;color:#4e6072;vertical-align:top;\">Policy No.</td>\r\n<td width=\"58%\" style=\"font-family:Arial,Helvetica,sans-serif;font-size:13px;color:#001e49;font-weight:bold;vertical-align:top;\">{{policy_no}}</td>\r\n</tr></table></td>\r\n<td width=\"50%\" style=\"font-family:Arial,Helvetica,sans-serif;font-size:13px;color:#4e6072;letter-spacing:1px;vertical-align:top;\">\r\n<table width=\"100%\" cellpadding=\"0\" cellspacing=\"0\"><tr>\r\n<td width=\"42%\" style=\"font-family:Arial,Helvetica,sans-serif;font-size:13px;color:#4e6072;vertical-align:top;\">ID / Certificate No.</td>\r\n<td width=\"58%\" style=\"font-family:Arial,Helvetica,sans-serif;font-size:13px;color:#001e49;font-weight:bold;vertical-align:top;\">{{certificate_no}}</td>\r\n</tr></table></td>\r\n</tr>\r\n<tr>\r\n<td width=\"50%\" style=\"font-family:Arial,Helvetica,sans-serif;font-size:13px;color:#4e6072;letter-spacing:1px;vertical-align:top;\">\r\n<table width=\"100%\" cellpadding=\"0\" cellspacing=\"0\"><tr>\r\n<td width=\"42%\" style=\"font-family:Arial,Helvetica,sans-serif;font-size:13px;color:#4e6072;vertical-align:top;\">Family Physician</td>\r\n<td width=\"58%\" style=\"font-family:Arial,Helvetica,sans-serif;font-size:13px;color:#001e49;font-weight:bold;vertical-align:top;\">{{family_physician}}</td>\r\n</tr></table></td>\r\n<td width=\"50%\" style=\"font-family:Arial,Helvetica,sans-serif;font-size:13px;color:#4e6072;letter-spacing:1px;vertical-align:top;\">\r\n<table width=\"100%\" cellpadding=\"0\" cellspacing=\"0\"><tr>\r\n<td width=\"42%\" style=\"font-family:Arial,Helvetica,sans-serif;font-size:13px;color:#4e6072;vertical-align:top;\">Physician Phone</td>\r\n<td width=\"58%\" style=\"font-family:Arial,Helvetica,sans-serif;font-size:13px;color:#001e49;font-weight:bold;vertical-align:top;\">{{physician_phone}}</td>\r\n</tr></table></td>\r\n</tr>\r\n<tr>\r\n<td width=\"50%\" style=\"font-family:Arial,Helvetica,sans-serif;font-size:13px;color:#4e6072;letter-spacing:1px;vertical-align:top;\">\r\n<table width=\"100%\" cellpadding=\"0\" cellspacing=\"0\"><tr>\r\n<td width=\"42%\" style=\"font-family:Arial,Helvetica,sans-serif;font-size:13px;color:#4e6072;vertical-align:top;\">Previous Dentist</td>\r\n<td width=\"58%\" style=\"font-family:Arial,Helvetica,sans-serif;font-size:13px;color:#001e49;font-weight:bold;vertical-align:top;\">{{previous_dentist}}</td>\r\n</tr></table></td>\r\n<td width=\"50%\" style=\"font-family:Arial,Helvetica,sans-serif;font-size:13px;color:#4e6072;letter-spacing:1px;vertical-align:top;\">\r\n<table width=\"100%\" cellpadding=\"0\" cellspacing=\"0\"><tr>\r\n<td width=\"42%\" style=\"font-family:Arial,Helvetica,sans-serif;font-size:13px;color:#4e6072;vertical-align:top;\">Previous Dentist Phone</td>\r\n<td width=\"58%\" style=\"font-family:Arial,Helvetica,sans-serif;font-size:13px;color:#001e49;font-weight:bold;vertical-align:top;\">{{previous_dentist_phone}}</td>\r\n</tr></table></td>\r\n</tr>\r\n<tr>\r\n<td colspan=\"2\" style=\"font-family:Arial,Helvetica,sans-serif;font-size:13px;color:#4e6072;letter-spacing:1px;vertical-align:top;\">\r\n<table width=\"100%\" cellpadding=\"0\" cellspacing=\"0\"><tr>\r\n<td width=\"20.5%\" style=\"font-family:Arial,Helvetica,sans-serif;font-size:13px;color:#4e6072;vertical-align:top;\">Referral Credit</td>\r\n<td width=\"79.5%\" style=\"font-family:Arial,Helvetica,sans-serif;font-size:13px;color:#001e49;font-weight:bold;vertical-align:top;\">{{referral_credit}}</td>\r\n</tr></table></td>\r\n</tr>\r\n</table></td></tr>\r\n                            </table>\r\n                        </td>\r\n                    </tr>\r\n\r\n                    <tr>\r\n                        <td style=\"padding:0 20px 30px 20px;\">\r\n                            <table width=\"100%\" cellpadding=\"0\" cellspacing=\"0\" style=\"border:1px solid #eae8e4;border-radius:8px;background:#f6f3ef;\">\r\n                                <tr><td style=\"background:#0e336a;padding:12px 14px;border-top-left-radius:8px;border-top-right-radius:8px;\"><h3 style=\"margin:0;font-family:Arial,Helvetica,sans-serif;font-size:12px;color:#ffffff;letter-spacing:1px;\">EMERGENCY CONTACT</h3></td></tr>\r\n                                <tr><td style=\"padding:20px;\"><table width=\"100%\" cellpadding=\"10\" cellspacing=\"0\">\r\n<tr>\r\n<td width=\"50%\" style=\"font-family:Arial,Helvetica,sans-serif;font-size:13px;color:#4e6072;letter-spacing:1px;vertical-align:top;\">\r\n<table width=\"100%\" cellpadding=\"0\" cellspacing=\"0\"><tr>\r\n<td width=\"42%\" style=\"font-family:Arial,Helvetica,sans-serif;font-size:13px;color:#4e6072;vertical-align:top;\">Contact Name</td>\r\n<td width=\"58%\" style=\"font-family:Arial,Helvetica,sans-serif;font-size:13px;color:#001e49;font-weight:bold;vertical-align:top;\">{{en_contact_name}}</td>\r\n</tr></table></td>\r\n<td width=\"50%\" style=\"font-family:Arial,Helvetica,sans-serif;font-size:13px;color:#4e6072;letter-spacing:1px;vertical-align:top;\">\r\n<table width=\"100%\" cellpadding=\"0\" cellspacing=\"0\"><tr>\r\n<td width=\"42%\" style=\"font-family:Arial,Helvetica,sans-serif;font-size:13px;color:#4e6072;vertical-align:top;\">Relationship</td>\r\n<td width=\"58%\" style=\"font-family:Arial,Helvetica,sans-serif;font-size:13px;color:#001e49;font-weight:bold;vertical-align:top;\">{{en_relationship}}</td>\r\n</tr></table></td>\r\n</tr>\r\n<tr>\r\n<td width=\"50%\" style=\"font-family:Arial,Helvetica,sans-serif;font-size:13px;color:#4e6072;letter-spacing:1px;vertical-align:top;\">\r\n<table width=\"100%\" cellpadding=\"0\" cellspacing=\"0\"><tr>\r\n<td width=\"42%\" style=\"font-family:Arial,Helvetica,sans-serif;font-size:13px;color:#4e6072;vertical-align:top;\">Address</td>\r\n<td width=\"58%\" style=\"font-family:Arial,Helvetica,sans-serif;font-size:13px;color:#001e49;font-weight:bold;vertical-align:top;\">{{en_address}}</td>\r\n</tr></table></td>\r\n<td width=\"50%\" style=\"font-family:Arial,Helvetica,sans-serif;font-size:13px;color:#4e6072;letter-spacing:1px;vertical-align:top;\">\r\n<table width=\"100%\" cellpadding=\"0\" cellspacing=\"0\"><tr>\r\n<td width=\"42%\" style=\"font-family:Arial,Helvetica,sans-serif;font-size:13px;color:#4e6072;vertical-align:top;\">Phone Number</td>\r\n<td width=\"58%\" style=\"font-family:Arial,Helvetica,sans-serif;font-size:13px;color:#001e49;font-weight:bold;vertical-align:top;\">{{en_phone_number}}</td>\r\n</tr></table></td>\r\n</tr>\r\n</table></td></tr>\r\n                            </table>\r\n                        </td>\r\n                    </tr>\r\n\r\n                    <tr>\r\n                        <td style=\"padding:0 20px 30px 20px;\">\r\n                            <table width=\"100%\" cellpadding=\"0\" cellspacing=\"0\" style=\"border:1px solid #eae8e4;border-radius:8px;\">\r\n                                <tr><td style=\"background:#0e336a;padding:12px 14px;border-top-left-radius:8px;border-top-right-radius:8px;\"><h3 style=\"margin:0;font-family:Arial,Helvetica,sans-serif;font-size:12px;color:#ffffff;letter-spacing:1px;\">CONFIDENTIAL MEDICAL HISTORY</h3></td></tr>\r\n                                <tr><td style=\"padding:20px;\"><table width=\"100%\" cellpadding=\"10\" cellspacing=\"0\">\r\n<tr><td style=\"font-family:Arial,Helvetica,sans-serif;font-size:13px;color:#4e6072;letter-spacing:1px;vertical-align:top;border-bottom:1px solid #f0ede9;\">\r\n<p style=\"margin:0 0 5px 0;\">1. Date of last complete physical examination</p>\r\n<p style=\"margin:0;font-weight:bold;color:#001e49;\">{{dlcp_examination}}</p>\r\n</td></tr>\r\n<tr><td style=\"font-family:Arial,Helvetica,sans-serif;font-size:13px;color:#4e6072;letter-spacing:1px;vertical-align:top;border-bottom:1px solid #f0ede9;\">\r\n<p style=\"margin:0 0 5px 0;\">2. Are you currently under a physician\'s care?</p>\r\n<p style=\"margin:0;font-weight:bold;color:#001e49;\">{{cup_care}}</p><p style=\"margin:4px 0 0 0;font-size:12px;color:#4e6072;\"><strong>Specify:</strong> {{cup_care_specify}}</p>\r\n</td></tr>\r\n<tr><td style=\"font-family:Arial,Helvetica,sans-serif;font-size:13px;color:#4e6072;letter-spacing:1px;vertical-align:top;border-bottom:1px solid #f0ede9;\">\r\n<p style=\"margin:0 0 5px 0;\">3. Do you have frequent headaches?</p>\r\n<p style=\"margin:0;font-weight:bold;color:#001e49;\">{{frequent_headaches}}</p>\r\n</td></tr>\r\n<tr><td style=\"font-family:Arial,Helvetica,sans-serif;font-size:13px;color:#4e6072;letter-spacing:1px;vertical-align:top;border-bottom:1px solid #f0ede9;\">\r\n<p style=\"margin:0 0 5px 0;\">4. Do you smoke?</p>\r\n<p style=\"margin:0;font-weight:bold;color:#001e49;\">{{smoke}}</p>\r\n</td></tr>\r\n<tr><td style=\"font-family:Arial,Helvetica,sans-serif;font-size:13px;color:#4e6072;letter-spacing:1px;vertical-align:top;border-bottom:1px solid #f0ede9;\">\r\n<p style=\"margin:0 0 5px 0;\">5. Do you drink alcohol?</p>\r\n<p style=\"margin:0;font-weight:bold;color:#001e49;\">{{drink_alcohol}}</p><p style=\"margin:4px 0 0 0;font-size:12px;color:#4e6072;\"><strong>Specify:</strong> {{drink_alcohol_specify}}</p>\r\n</td></tr>\r\n<tr><td style=\"font-family:Arial,Helvetica,sans-serif;font-size:13px;color:#4e6072;letter-spacing:1px;vertical-align:top;border-bottom:1px solid #f0ede9;\">\r\n<p style=\"margin:0 0 5px 0;\">6. Do you do recreational drugs?</p>\r\n<p style=\"margin:0;font-weight:bold;color:#001e49;\">{{recreational_drugs}}</p>\r\n</td></tr>\r\n<tr><td style=\"font-family:Arial,Helvetica,sans-serif;font-size:13px;color:#4e6072;letter-spacing:1px;vertical-align:top;border-bottom:1px solid #f0ede9;\">\r\n<p style=\"margin:0 0 5px 0;\">7. Do you routinely take vitamins, herbal substances, or natural products?</p>\r\n<p style=\"margin:0;font-weight:bold;color:#001e49;\">{{herbal_substances}}</p><p style=\"margin:4px 0 0 0;font-size:12px;color:#4e6072;\"><strong>Specify:</strong> {{herbal_substances_specify}}</p>\r\n</td></tr>\r\n<tr><td style=\"font-family:Arial,Helvetica,sans-serif;font-size:13px;color:#4e6072;letter-spacing:1px;vertical-align:top;border-bottom:1px solid #f0ede9;\">\r\n<p style=\"margin:0 0 5px 0;\">8. Are you taking any medications?</p>\r\n<p style=\"margin:0;font-weight:bold;color:#001e49;\">{{any_medications}}</p><p style=\"margin:4px 0 0 0;font-size:12px;color:#4e6072;\"><strong>Specify:</strong> {{any_medications_specify}}</p>\r\n</td></tr>\r\n<tr><td style=\"font-family:Arial,Helvetica,sans-serif;font-size:13px;color:#4e6072;letter-spacing:1px;vertical-align:top;border-bottom:1px solid #f0ede9;\">\r\n<p style=\"margin:0 0 5px 0;\">9. Have you taken any prolonged medication in the past?</p>\r\n<p style=\"margin:0;font-weight:bold;color:#001e49;\">{{prolonged_medication}}</p><p style=\"margin:4px 0 0 0;font-size:12px;color:#4e6072;\"><strong>Specify:</strong> {{prolonged_medication_specify}}</p>\r\n</td></tr>\r\n<tr><td style=\"font-family:Arial,Helvetica,sans-serif;font-size:13px;color:#4e6072;letter-spacing:1px;vertical-align:top;border-bottom:1px solid #f0ede9;\">\r\n<p style=\"margin:0 0 5px 0;\">10. Have you taken cortisone or steroids?</p>\r\n<p style=\"margin:0;font-weight:bold;color:#001e49;\">{{cortisone}}</p>\r\n</td></tr>\r\n<tr><td style=\"font-family:Arial,Helvetica,sans-serif;font-size:13px;color:#4e6072;letter-spacing:1px;vertical-align:top;border-bottom:1px solid #f0ede9;\">\r\n<p style=\"margin:0 0 5px 0;\">11. Have you ever been hospitalized for any surgery?</p>\r\n<p style=\"margin:0;font-weight:bold;color:#001e49;\">{{any_surgery}}</p><p style=\"margin:4px 0 0 0;font-size:12px;color:#4e6072;\"><strong>Specify:</strong> {{any_surgery_specify}}</p>\r\n</td></tr>\r\n<tr><td style=\"font-family:Arial,Helvetica,sans-serif;font-size:13px;color:#4e6072;letter-spacing:1px;vertical-align:top;border-bottom:1px solid #f0ede9;\">\r\n<p style=\"margin:0 0 5px 0;\">12. Are your ankles often swollen?</p>\r\n<p style=\"margin:0;font-weight:bold;color:#001e49;\">{{ankles_swollen}}</p>\r\n</td></tr>\r\n<tr><td style=\"font-family:Arial,Helvetica,sans-serif;font-size:13px;color:#4e6072;letter-spacing:1px;vertical-align:top;border-bottom:1px solid #f0ede9;\">\r\n<p style=\"margin:0 0 5px 0;\">13. Have you gained or lost excessive weight recently?</p>\r\n<p style=\"margin:0;font-weight:bold;color:#001e49;\">{{gained_lost_weight}}</p>\r\n</td></tr>\r\n<tr><td style=\"font-family:Arial,Helvetica,sans-serif;font-size:13px;color:#4e6072;letter-spacing:1px;vertical-align:top;border-bottom:1px solid #f0ede9;\">\r\n<p style=\"margin:0 0 5px 0;\">14. Are you pregnant?</p>\r\n<p style=\"margin:0;font-weight:bold;color:#001e49;\">{{pregnant}}</p><p style=\"margin:4px 0 0 0;font-size:12px;color:#4e6072;\"><strong>Specify:</strong> {{pregnant_weeks}}</p>\r\n</td></tr>\r\n<tr><td style=\"font-family:Arial,Helvetica,sans-serif;font-size:13px;color:#4e6072;letter-spacing:1px;vertical-align:top;border-bottom:1px solid #f0ede9;\">\r\n<p style=\"margin:0 0 5px 0;\">15. Sensitive / adverse reactions</p>\r\n<p style=\"margin:0;font-weight:bold;color:#001e49;\">{{adverse_reaction}}</p>\r\n</td></tr>\r\n<tr><td style=\"font-family:Arial,Helvetica,sans-serif;font-size:13px;color:#4e6072;letter-spacing:1px;vertical-align:top;border-bottom:1px solid #f0ede9;\">\r\n<p style=\"margin:0 0 5px 0;\">16. Allergies / adverse reactions</p>\r\n<p style=\"margin:0;font-weight:bold;color:#001e49;\">{{allergic_adverse_reaction}}</p>\r\n</td></tr>\r\n<tr><td style=\"font-family:Arial,Helvetica,sans-serif;font-size:13px;color:#4e6072;letter-spacing:1px;vertical-align:top;border-bottom:1px solid #f0ede9;\">\r\n<p style=\"margin:0 0 5px 0;\">17. Allergic or adverse reactions to any other drugs?</p>\r\n<p style=\"margin:0;font-weight:bold;color:#001e49;\">{{adverse_reactions}}</p><p style=\"margin:4px 0 0 0;font-size:12px;color:#4e6072;\"><strong>Specify:</strong> {{adverse_reactions_specify}}</p>\r\n</td></tr>\r\n<tr><td style=\"font-family:Arial,Helvetica,sans-serif;font-size:13px;color:#4e6072;letter-spacing:1px;vertical-align:top;border-bottom:1px solid #f0ede9;\">\r\n<p style=\"margin:0 0 5px 0;\">18. Treated for or told you have any of the following</p>\r\n<p style=\"margin:0;font-weight:bold;color:#001e49;\">{{treated}}</p>\r\n</td></tr>\r\n<tr><td style=\"font-family:Arial,Helvetica,sans-serif;font-size:13px;color:#4e6072;letter-spacing:1px;vertical-align:top;border-bottom:1px solid #f0ede9;\">\r\n<p style=\"margin:0 0 5px 0;\">19. Have you ever experienced heavy bleeding?</p>\r\n<p style=\"margin:0;font-weight:bold;color:#001e49;\">{{heavy_bleeding}}</p>\r\n</td></tr>\r\n<tr><td style=\"font-family:Arial,Helvetica,sans-serif;font-size:13px;color:#4e6072;letter-spacing:1px;vertical-align:top;border-bottom:1px solid #f0ede9;\">\r\n<p style=\"margin:0 0 5px 0;\">20. Is there anything else we should know?</p>\r\n<p style=\"margin:0;font-weight:bold;color:#001e49;\">{{anything_else_know}}</p><p style=\"margin:4px 0 0 0;font-size:12px;color:#4e6072;\"><strong>Specify:</strong> {{anything_else_know_specify}}</p>\r\n</td></tr>\r\n<tr><td style=\"font-family:Arial,Helvetica,sans-serif;font-size:13px;color:#4e6072;letter-spacing:1px;vertical-align:top;border-bottom:1px solid #f0ede9;\">\r\n<p style=\"margin:0 0 5px 0;\">21. Have you been diagnosed with any other disease, condition or problem?</p>\r\n<p style=\"margin:0;font-weight:bold;color:#001e49;\">{{other_disease}}</p>\r\n</td></tr>\r\n<tr><td style=\"font-family:Arial,Helvetica,sans-serif;font-size:13px;color:#4e6072;letter-spacing:1px;vertical-align:top;border-bottom:1px solid #f0ede9;\">\r\n<p style=\"margin:0 0 5px 0;\">22. Is there anything about your health we should be aware of?</p>\r\n<p style=\"margin:0;font-weight:bold;color:#001e49;\">{{anything_about_health}}</p><p style=\"margin:4px 0 0 0;font-size:12px;color:#4e6072;\"><strong>Specify:</strong> {{anything_about_health_specify}}</p>\r\n</td></tr>\r\n<tr><td style=\"font-family:Arial,Helvetica,sans-serif;font-size:13px;color:#4e6072;letter-spacing:1px;vertical-align:top;border-bottom:1px solid #f0ede9;\">\r\n<p style=\"margin:0 0 5px 0;\">23. Do you wish to speak to the doctor privately?</p>\r\n<p style=\"margin:0;font-weight:bold;color:#001e49;\">{{speak_doctor_privately}}</p>\r\n</td></tr>\r\n</table></td></tr>\r\n                            </table>\r\n                        </td>\r\n                    </tr>\r\n\r\n                    <tr>\r\n                        <td style=\"padding:0 20px 30px 20px;\">\r\n                            <table width=\"100%\" cellpadding=\"0\" cellspacing=\"0\" style=\"border:1px solid #eae8e4;border-radius:8px;\">\r\n                                <tr><td style=\"background:#0e336a;padding:12px 14px;border-top-left-radius:8px;border-top-right-radius:8px;\"><h3 style=\"margin:0;font-family:Arial,Helvetica,sans-serif;font-size:12px;color:#ffffff;letter-spacing:1px;\">DENTAL HISTORY</h3></td></tr>\r\n                                <tr><td style=\"padding:20px;\"><table width=\"100%\" cellpadding=\"10\" cellspacing=\"0\">\r\n<tr><td style=\"font-family:Arial,Helvetica,sans-serif;font-size:13px;color:#4e6072;letter-spacing:1px;vertical-align:top;border-bottom:1px solid #f0ede9;\">\r\n<p style=\"margin:0 0 5px 0;\">24. Date of last complete exam</p>\r\n<p style=\"margin:0;font-weight:bold;color:#001e49;\">{{date_last_complete_exam}}</p>\r\n</td></tr>\r\n<tr><td style=\"font-family:Arial,Helvetica,sans-serif;font-size:13px;color:#4e6072;letter-spacing:1px;vertical-align:top;border-bottom:1px solid #f0ede9;\">\r\n<p style=\"margin:0 0 5px 0;\">25. Date of last cleaning</p>\r\n<p style=\"margin:0;font-weight:bold;color:#001e49;\">{{date_last_cleaning}}</p>\r\n</td></tr>\r\n<tr><td style=\"font-family:Arial,Helvetica,sans-serif;font-size:13px;color:#4e6072;letter-spacing:1px;vertical-align:top;border-bottom:1px solid #f0ede9;\">\r\n<p style=\"margin:0 0 5px 0;\">26. Date of last x-rays</p>\r\n<p style=\"margin:0;font-weight:bold;color:#001e49;\">{{date_last_x_rays}}</p>\r\n</td></tr>\r\n<tr><td style=\"font-family:Arial,Helvetica,sans-serif;font-size:13px;color:#4e6072;letter-spacing:1px;vertical-align:top;border-bottom:1px solid #f0ede9;\">\r\n<p style=\"margin:0 0 5px 0;\">27. Did you see your last dentist regularly?</p>\r\n<p style=\"margin:0;font-weight:bold;color:#001e49;\">{{last_dentist_regularly}}</p>\r\n</td></tr>\r\n<tr><td style=\"font-family:Arial,Helvetica,sans-serif;font-size:13px;color:#4e6072;letter-spacing:1px;vertical-align:top;border-bottom:1px solid #f0ede9;\">\r\n<p style=\"margin:0 0 5px 0;\">28. How often did you see your last dentist?</p>\r\n<p style=\"margin:0;font-weight:bold;color:#001e49;\">{{last_dentist}}</p><p style=\"margin:4px 0 0 0;font-size:12px;color:#4e6072;\"><strong>Specify:</strong> {{last_dentist_description}}</p>\r\n</td></tr>\r\n<tr><td style=\"font-family:Arial,Helvetica,sans-serif;font-size:13px;color:#4e6072;letter-spacing:1px;vertical-align:top;border-bottom:1px solid #f0ede9;\">\r\n<p style=\"margin:0 0 5px 0;\">29. Have you ever been advised to take antibiotics?</p>\r\n<p style=\"margin:0;font-weight:bold;color:#001e49;\">{{antibiotics}}</p>\r\n</td></tr>\r\n<tr><td style=\"font-family:Arial,Helvetica,sans-serif;font-size:13px;color:#4e6072;letter-spacing:1px;vertical-align:top;border-bottom:1px solid #f0ede9;\">\r\n<p style=\"margin:0 0 5px 0;\">30. Heavy bleeding following extractions?</p>\r\n<p style=\"margin:0;font-weight:bold;color:#001e49;\">{{heavy_bleeding_extractions}}</p>\r\n</td></tr>\r\n<tr><td style=\"font-family:Arial,Helvetica,sans-serif;font-size:13px;color:#4e6072;letter-spacing:1px;vertical-align:top;border-bottom:1px solid #f0ede9;\">\r\n<p style=\"margin:0 0 5px 0;\">31. Have you ever had gum treatment or surgery?</p>\r\n<p style=\"margin:0;font-weight:bold;color:#001e49;\">{{gum_treatment}}</p>\r\n</td></tr>\r\n<tr><td style=\"font-family:Arial,Helvetica,sans-serif;font-size:13px;color:#4e6072;letter-spacing:1px;vertical-align:top;border-bottom:1px solid #f0ede9;\">\r\n<p style=\"margin:0 0 5px 0;\">32. Have you had any orthodontic treatment?</p>\r\n<p style=\"margin:0;font-weight:bold;color:#001e49;\">{{orthodontic_treatment}}</p>\r\n</td></tr>\r\n<tr><td style=\"font-family:Arial,Helvetica,sans-serif;font-size:13px;color:#4e6072;letter-spacing:1px;vertical-align:top;border-bottom:1px solid #f0ede9;\">\r\n<p style=\"margin:0 0 5px 0;\">33. Have you ever had an unpleasant dental experience?</p>\r\n<p style=\"margin:0;font-weight:bold;color:#001e49;\">{{unpleasant_dental_experience}}</p>\r\n</td></tr>\r\n<tr><td style=\"font-family:Arial,Helvetica,sans-serif;font-size:13px;color:#4e6072;letter-spacing:1px;vertical-align:top;border-bottom:1px solid #f0ede9;\">\r\n<p style=\"margin:0 0 5px 0;\">34. How can we make your dental experience more pleasant?</p>\r\n<p style=\"margin:0;font-weight:bold;color:#001e49;\">{{pleasant_dental_experience}}</p>\r\n</td></tr>\r\n<tr><td style=\"font-family:Arial,Helvetica,sans-serif;font-size:13px;color:#4e6072;letter-spacing:1px;vertical-align:top;border-bottom:1px solid #f0ede9;\">\r\n<p style=\"margin:0 0 5px 0;\">35. Is there anything else we should know?</p>\r\n<p style=\"margin:0;font-weight:bold;color:#001e49;\">{{anything_else_should_know}}</p>\r\n</td></tr>\r\n<tr><td style=\"font-family:Arial,Helvetica,sans-serif;font-size:13px;color:#4e6072;letter-spacing:1px;vertical-align:top;border-bottom:1px solid #f0ede9;\">\r\n<p style=\"margin:0 0 5px 0;\">36. What brings you to the office today?</p>\r\n<p style=\"margin:0;font-weight:bold;color:#001e49;\">{{brings_office_today}}</p>\r\n</td></tr>\r\n<tr><td style=\"font-family:Arial,Helvetica,sans-serif;font-size:13px;color:#4e6072;letter-spacing:1px;vertical-align:top;border-bottom:1px solid #f0ede9;\">\r\n<p style=\"margin:0 0 5px 0;\">37. Are you in any discomfort?</p>\r\n<p style=\"margin:0;font-weight:bold;color:#001e49;\">{{any_discomfort}}</p><p style=\"margin:4px 0 0 0;font-size:12px;color:#4e6072;\"><strong>Specify:</strong> {{any_discomfort_specify}}</p>\r\n</td></tr>\r\n<tr><td style=\"font-family:Arial,Helvetica,sans-serif;font-size:13px;color:#4e6072;letter-spacing:1px;vertical-align:top;border-bottom:1px solid #f0ede9;\">\r\n<p style=\"margin:0 0 5px 0;\">38. Do you have or have you experienced</p>\r\n<p style=\"margin:0;font-weight:bold;color:#001e49;\">{{have_experienced}}</p>\r\n</td></tr>\r\n<tr><td style=\"font-family:Arial,Helvetica,sans-serif;font-size:13px;color:#4e6072;letter-spacing:1px;vertical-align:top;border-bottom:1px solid #f0ede9;\">\r\n<p style=\"margin:0 0 5px 0;\">39. Does food get caught between your teeth?</p>\r\n<p style=\"margin:0;font-weight:bold;color:#001e49;\">{{food_teeth}}</p>\r\n</td></tr>\r\n<tr><td style=\"font-family:Arial,Helvetica,sans-serif;font-size:13px;color:#4e6072;letter-spacing:1px;vertical-align:top;border-bottom:1px solid #f0ede9;\">\r\n<p style=\"margin:0 0 5px 0;\">40. Do you have any sore spots in your mouth?</p>\r\n<p style=\"margin:0;font-weight:bold;color:#001e49;\">{{sore_spots}}</p>\r\n</td></tr>\r\n<tr><td style=\"font-family:Arial,Helvetica,sans-serif;font-size:13px;color:#4e6072;letter-spacing:1px;vertical-align:top;border-bottom:1px solid #f0ede9;\">\r\n<p style=\"margin:0 0 5px 0;\">41. Have you had any teeth replaced?</p>\r\n<p style=\"margin:0;font-weight:bold;color:#001e49;\">{{teeth_replaced}}</p>\r\n</td></tr>\r\n<tr><td style=\"font-family:Arial,Helvetica,sans-serif;font-size:13px;color:#4e6072;letter-spacing:1px;vertical-align:top;border-bottom:1px solid #f0ede9;\">\r\n<p style=\"margin:0 0 5px 0;\">42. Interested in permanent tooth replacement?</p>\r\n<p style=\"margin:0;font-weight:bold;color:#001e49;\">{{permanent_tooth_replacement}}</p>\r\n</td></tr>\r\n<tr><td style=\"font-family:Arial,Helvetica,sans-serif;font-size:13px;color:#4e6072;letter-spacing:1px;vertical-align:top;border-bottom:1px solid #f0ede9;\">\r\n<p style=\"margin:0 0 5px 0;\">43. Have you ever been given local anesthesia?</p>\r\n<p style=\"margin:0;font-weight:bold;color:#001e49;\">{{local_anesthesia}}</p>\r\n</td></tr>\r\n<tr><td style=\"font-family:Arial,Helvetica,sans-serif;font-size:13px;color:#4e6072;letter-spacing:1px;vertical-align:top;border-bottom:1px solid #f0ede9;\">\r\n<p style=\"margin:0 0 5px 0;\">44. Have you ever been given general anesthesia?</p>\r\n<p style=\"margin:0;font-weight:bold;color:#001e49;\">{{general_anesthesia}}</p>\r\n</td></tr>\r\n<tr><td style=\"font-family:Arial,Helvetica,sans-serif;font-size:13px;color:#4e6072;letter-spacing:1px;vertical-align:top;border-bottom:1px solid #f0ede9;\">\r\n<p style=\"margin:0 0 5px 0;\">45. Are you satisfied with the appearance of your teeth?</p>\r\n<p style=\"margin:0;font-weight:bold;color:#001e49;\">{{satisfied_appearance_teeth}}</p>\r\n</td></tr>\r\n<tr><td style=\"font-family:Arial,Helvetica,sans-serif;font-size:13px;color:#4e6072;letter-spacing:1px;vertical-align:top;border-bottom:1px solid #f0ede9;\">\r\n<p style=\"margin:0 0 5px 0;\">46. Are you anxious to keep your natural teeth?</p>\r\n<p style=\"margin:0;font-weight:bold;color:#001e49;\">{{keep_natural_teeth}}</p>\r\n</td></tr>\r\n<tr><td style=\"font-family:Arial,Helvetica,sans-serif;font-size:13px;color:#4e6072;letter-spacing:1px;vertical-align:top;border-bottom:1px solid #f0ede9;\">\r\n<p style=\"margin:0 0 5px 0;\">47. Are you tense during dental visits?</p>\r\n<p style=\"margin:0;font-weight:bold;color:#001e49;\">{{tense_dental_visits}}</p>\r\n</td></tr>\r\n<tr><td style=\"font-family:Arial,Helvetica,sans-serif;font-size:13px;color:#4e6072;letter-spacing:1px;vertical-align:top;border-bottom:1px solid #f0ede9;\">\r\n<p style=\"margin:0 0 5px 0;\">48. Interested in a method to calm your nerves?</p>\r\n<p style=\"margin:0;font-weight:bold;color:#001e49;\">{{calm_nerves}}</p>\r\n</td></tr>\r\n<tr><td style=\"font-family:Arial,Helvetica,sans-serif;font-size:13px;color:#4e6072;letter-spacing:1px;vertical-align:top;border-bottom:1px solid #f0ede9;\">\r\n<p style=\"margin:0 0 5px 0;\">49. How can we help you today?</p>\r\n<p style=\"margin:0;font-weight:bold;color:#001e49;\">{{describe}}</p>\r\n</td></tr>\r\n</table></td></tr>\r\n                            </table>\r\n                        </td>\r\n                    </tr>\r\n                    <tr>\r\n                        <td style=\"padding:0 20px 30px 20px;\">\r\n                            <table width=\"100%\" cellpadding=\"0\" cellspacing=\"0\"\r\n                                style=\"background:#0e336a; border-radius:16px;\">\r\n                                <tr>\r\n                                    <td colspan=\"2\" style=\"padding:12px 14px;\">\r\n                                        <h3\r\n                                            style=\"margin:15px 0 5px 15px;font-family:Arial,Helvetica,sans-serif;font-size:16px;color:#ffffff;letter-spacing:1px;\">\r\n                                            Patient Consent</h3>\r\n                                        <p\r\n                                            style=\"margin:0 0 0 15px;font-family:Arial,Helvetica,sans-serif;font-size:12px;color:#ffffff;letter-spacing:1px;\">\r\n                                            Verified & Authorized Digital Copy</p>\r\n                                    </td>\r\n                                </tr>\r\n                                <tr>\r\n                                    <td width=\"60%\" style=\"padding:0 20px 20px 20px;vertical-align: top;\">\r\n                                        <table width=\"100%\" cellpadding=\"0\" cellspacing=\"0\">\r\n                                            <tr>\r\n                                                <td style=\"font-family:Arial,Helvetica,sans-serif;font-size:13px;color:#ffffff;letter-spacing:1px;vertical-align:top;\">\r\n                                                    <p style=\"margin:0 0 10px 15px;\">{{consent_privacy_patient_icon}}&nbsp;&nbsp;I agree to the privacy policy regarding medical records.</p>\r\n                                                </td>\r\n                                            </tr>\r\n                                            <tr>\r\n                                                <td style=\"font-family:Arial,Helvetica,sans-serif;font-size:13px;color:#ffffff;letter-spacing:1px;vertical-align:top;\">\r\n                                                    <p style=\"margin:0 0 0 15px;\">{{consent_newsletter_icon}}&nbsp;&nbsp;I consent to receiving emails and newsletters.</p>\r\n                                                </td>\r\n                                            </tr>\r\n                                        </table>\r\n                                    </td>\r\n                                    <td width=\"40%\" style=\"padding:0 20px 20px 20px;vertical-align: top;\">\r\n                                        <table width=\"100%\" cellpadding=\"0\" cellspacing=\"0\">\r\n                                            <tr>\r\n                                                <td style=\"font-family:Arial,Helvetica,sans-serif;font-size:13px;color:#ffffff;letter-spacing:1px;vertical-align:top;\">\r\n                                                    <p style=\"margin:0 0 5px 0;\">SIGNATURE</p>\r\n                                                    <img src=\"{{signature}}\" alt=\"Signature\" style=\"max-width: 150px; max-height: 70px; border: 1px solid #ccc; padding: 4px; background: #fff;margin: 0 0 20px 0;\">\r\n                                                </td>\r\n                                            </tr>\r\n                                            <tr>\r\n                                                <td style=\"font-family:Arial,Helvetica,sans-serif;font-size:13px;color:#ffffff;letter-spacing:1px;vertical-align:top;\">\r\n                                                    <p style=\"margin:0 0 5px 0;\">PRINT NAME</p>\r\n                                                    <p style=\"margin:0;\">{{print_name}}</p>\r\n                                                </td>\r\n                                            </tr>\r\n                                        </table>\r\n                                    </td>\r\n                                </tr>\r\n                            </table>\r\n                        </td>\r\n                    </tr>\r\n                    <tr>\r\n                        <td style=\"border-top: 1px solid #eae8e4;\">\r\n                            &nbsp;\r\n                        </td>\r\n                    </tr>\r\n                    <tr>\r\n                        <td align=\"center\">\r\n                            <img src=\"https://chaggerdental.com/themes/frontend/images/dental-logo.png\"\r\n                                width=\"250\" alt=\"Chagger Dental\">\r\n                        </td>\r\n                    </tr>\r\n                    <tr>\r\n                        <td align=\"center\" style=\"padding:18px;font-size:13px;color:#434750;\">\r\n                            &copy; {{year}} Chagger Dental &bull; Confidential Medical Record\r\n                        </td>\r\n                    </tr>\r\n                </table>\r\n            </td>\r\n        </tr>\r\n        <tr>\r\n            <td align=\"center\" style=\"padding:20px;font-size:14px;\">\r\n                <b>Note:</b> Please do not reply to this email.\r\n            </td>\r\n        </tr>\r\n    </table>\r\n</body>\r\n\r\n</html>', NULL, NULL, 'vikash@tastechnologies.com', NULL, NULL, 1, 1, '2026-05-14 22:57:56', '2026-05-18 09:01:05');
INSERT INTO `cdt_email_template` (`et_id`, `template_name`, `subject`, `message_template_type`, `message_template`, `from_name`, `from_email`, `to_emails`, `cc_emails`, `bcc_emails`, `created_id`, `updated_id`, `created_at`, `updated_at`) VALUES
(9, 'User New Patient Registration Enquiry Confirmation', 'New Patient Registration Enquiry - Chagger Dental', 'Full', '<!DOCTYPE html>\r\n<html>\r\n\r\n<head>\r\n    <meta charset=\"UTF-8\">\r\n    <title>Chagger Dental</title>\r\n</head>\r\n\r\n<body style=\"margin:0;padding:0;background:#e9ecef;font-family:Arial,Helvetica,sans-serif;\">\r\n    <table width=\"100%\" cellpadding=\"0\" cellspacing=\"0\" style=\"background:#e9ecef;padding:30px 0;\">\r\n        <tr>\r\n            <td align=\"center\">\r\n\r\n                <table width=\"700\" cellpadding=\"0\" cellspacing=\"0\" style=\"background:#ffffff;border-radius: 16px;\r\n    border: 4px solid #2f5f9e;\">\r\n\r\n                    <!-- LOGO -->\r\n                    <tr>\r\n                        <td align=\"center\" style=\"padding:20px 20px;\">\r\n                            <img src=\"https://chaggerdental.com/themes/frontend/images/dental-logo.png\" width=\"255\">\r\n                        </td>\r\n                    </tr>\r\n\r\n                    <!-- HEADER -->\r\n                    <tr>\r\n                        <td style=\"background:#2f5f9e;color:#ffffff;text-align:center;font-size:18px;padding:18px;\">\r\n                            Hi {{full_name}},\r\n                        </td>\r\n                    </tr>\r\n\r\n                    <!-- FORM DATA -->\r\n                    <tr>\r\n                        <td style=\"padding:30px;padding-bottom: 0px;\">\r\n                            <table width=\"100%\" cellpadding=\"10\" cellspacing=\"0\">\r\n                                <tr>\r\n                                    <p style=\"font-size: 0.9em; margin-top: 0;\">Thank you for reaching out to us.</p>\r\n                                    <p style=\"font-size: 0.9em; margin-top: 0; margin-bottom: 0; line-height: 1.3em;\">We have received your new patient registration enquiry and our team will review your message shortly. One of our representatives will get back to you as soon as possible.</p>\r\n                                </tr>\r\n                            </table>\r\n                        </td>\r\n                    </tr>\r\n\r\n                    <!-- NOTE -->\r\n                    <tr>\r\n                        <td align=\"center\" style=\"padding:20px;font-size:14px;\">\r\n                            <b>Note:</b> Please do not reply to this email.\r\n                        </td>\r\n                    </tr>\r\n\r\n                    <!-- CONTACT FOOTER -->\r\n                    <tr>\r\n                        <td style=\"background:#2f5f9e;padding:25px;\">\r\n                            <table width=\"100%\" cellpadding=\"0\" cellspacing=\"0\">\r\n                                <tr>\r\n\r\n                                    <!-- LEFT -->\r\n                                    <td width=\"50%\" style=\"color:#ffffff;font-size:16px;\">\r\n                                        <b>Location:</b> {{location_name}}<br><br>\r\n                                        <b>Email:</b> <a href=\"mailto:{{location_email}}\"\r\n                                        style=\"color:#ffffff; text-decoration:none;\">{{location_email}}</a>\r\n                                    </td>\r\n\r\n                                    <!-- RIGHT -->\r\n                                    <td width=\"50%\" style=\"color:#ffffff;font-size:16px;\">\r\n                                        <b>Call Us:</b> {{location_phone}}<br><br>\r\n                                        <b>Address:</b><br>\r\n                                        {{location_address}}\r\n                                    </td>\r\n\r\n                                </tr>\r\n                            </table>\r\n                        </td>\r\n                    </tr>\r\n\r\n                    <!-- COPYRIGHT -->\r\n                    <tr>\r\n                        <td align=\"center\" style=\"padding:18px;font-size:13px;color:#555;\">\r\n                            © {{year}} Chagger Dental, All Rights Reserved.\r\n                        </td>\r\n                    </tr>\r\n\r\n                </table>\r\n\r\n            </td>\r\n        </tr>\r\n    </table>\r\n</body>\r\n\r\n</html>', NULL, NULL, NULL, NULL, NULL, 1, 1, '2026-05-14 22:59:21', '2026-05-14 22:59:21');

-- --------------------------------------------------------

--
-- Table structure for table `cdt_failed_jobs`
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  `payload` longtext COLLATE utf8mb4_unicode_ci NOT NULL,
  `exception` longtext COLLATE utf8mb4_unicode_ci NOT NULL,
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-- Table structure for table `cdt_forms`
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  `id` bigint UNSIGNED NOT NULL,
  `form_name` varchar(255) COLLATE utf8mb4_unicode_ci NOT NULL,
  `form_slug` varchar(255) COLLATE utf8mb4_unicode_ci NOT NULL,
  `email_template_id` int UNSIGNED DEFAULT NULL,
  `admin_email_template_id` int UNSIGNED DEFAULT NULL,
  `status` enum('enabled','disabled') COLLATE utf8mb4_unicode_ci NOT NULL DEFAULT 'enabled',
  `created_id` int NOT NULL DEFAULT '0',
  `updated_id` int NOT NULL DEFAULT '0',
  `created_at` timestamp NULL DEFAULT NULL,
  `updated_at` timestamp NULL DEFAULT NULL,
  `deleted_at` timestamp NULL DEFAULT NULL
) ENGINE=InnoDB DEFAULT CHARSET=utf8mb4 COLLATE=utf8mb4_unicode_ci;

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(1, 'Quick Book an Appointment', 'quick-book-an-appointment', 3, 2, 'enabled', 1, 1, '2026-05-01 17:35:22', '2026-05-01 17:35:22', NULL),
(2, 'Book an Appointment', 'book-an-appointment', 5, 4, 'enabled', 1, 1, '2026-05-01 17:36:22', '2026-05-01 17:36:22', NULL),
(3, 'Contact Us', 'contact-us', 7, 6, 'enabled', 1, 1, '2026-05-02 17:36:22', '2026-05-02 17:36:22', NULL),
(4, 'New Patient Form', 'new-patient-form', 9, 8, 'enabled', 1, 1, '2026-05-12 17:36:22', '2026-05-12 17:36:22', NULL);

-- --------------------------------------------------------

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  `status` enum('enabled','disabled') COLLATE utf8mb4_unicode_ci NOT NULL DEFAULT 'enabled',
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(1, 1, 'preferred_location', 'Preferred Location', NULL, 'select', 1, NULL, 1, 'enabled', 1, 1, '2026-05-01 17:38:22', '2026-05-01 17:38:22', NULL),
(2, 1, 'services', 'Select Services', NULL, 'select', 1, '{\n    \"Family Dentistry\": \"Family Dentistry\",\n    \"Kids Dentistry\": \"Kids Dentistry\",\n    \"General Consultation\": \"General Consultation\"\n, \n    \"Cosmetic Dentistry\": \"Cosmetic Dentistry\"\n, \n    \"Dental Implants\": \"Dental Implants\"\n, \n    \"Teeth Whitening\": \"Teeth Whitening\"\n, \n    \"Emergency Care\": \"Emergency Care\"\n, \n    \"Others\": \"Others\"\n}', 2, 'enabled', 1, 1, '2026-05-01 17:38:22', '2026-05-01 17:38:22', NULL),
(3, 1, 'full_name', 'Full Name', 'John Doe', 'text', 1, NULL, 3, 'enabled', 1, 1, '2026-05-01 17:38:22', '2026-05-01 17:38:22', NULL),
(4, 1, 'phone_number', 'Phone Number', '+1 (555) 000-0000', 'text', 1, NULL, 4, 'enabled', 1, 1, '2026-05-01 17:38:22', '2026-05-01 17:38:22', NULL),
(5, 1, 'email_address', 'Email Address', 'john@example.com', 'email', 1, NULL, 5, 'enabled', 1, 1, '2026-05-01 17:38:22', '2026-05-01 17:38:22', NULL),
(6, 1, 'address', 'Address', 'Your Address', 'text', 1, NULL, 6, 'enabled', 1, 1, '2026-05-01 17:38:22', '2026-05-01 17:38:22', NULL),
(7, 1, 'preferred_date', 'Preferred Date', NULL, 'date', 1, NULL, 7, 'enabled', 1, 1, '2026-05-01 17:38:22', '2026-05-01 17:38:22', NULL),
(8, 1, 'preferred_time', 'Preferred Time To Call', NULL, 'radio', 1, '{\n    \"Morning\": \"Morning\",\n    \"Afternoon\": \"Afternoon\",\n    \"Evening\": \"Evening\"\n}', 8, 'enabled', 1, 1, '2026-05-01 17:38:22', '2026-05-01 17:38:22', NULL),
(9, 1, 'message', 'Message', 'Tell us about your dental goals or any concerns...', 'textarea', 1, NULL, 9, 'enabled', 1, 1, '2026-05-01 17:38:22', '2026-05-01 17:38:22', NULL),
(10, 2, 'patient_type', 'Patient Type', NULL, 'radio', 1, '{\n    \"New Patient\": \"New Patient\",\n    \"Returning Patient\": \"Returning Patient\"\n}', 1, 'enabled', 1, 1, '2026-05-01 17:38:22', '2026-05-01 17:38:22', NULL),
(11, 2, 'preferred_location', 'Preferred Location', NULL, 'select', 1, NULL, 2, 'enabled', 1, 1, '2026-05-01 17:38:22', '2026-05-01 17:38:22', NULL),
(12, 2, 'full_name', 'Full Name', 'John Doe', 'text', 1, NULL, 3, 'enabled', 1, 1, '2026-05-01 17:38:22', '2026-05-01 17:38:22', NULL),
(13, 2, 'phone_number', 'Phone Number', '+1 (555) 000-0000', 'text', 1, NULL, 4, 'enabled', 1, 1, '2026-05-01 17:38:22', '2026-05-01 17:38:22', NULL),
(14, 2, 'email_address', 'Email Address', 'john@example.com', 'email', 1, NULL, 5, 'enabled', 1, 1, '2026-05-01 17:38:22', '2026-05-01 17:38:22', NULL),
(15, 2, 'address', 'Address', 'Your Address', 'text', 1, NULL, 6, 'enabled', 1, 1, '2026-05-01 17:38:22', '2026-05-01 17:38:22', NULL),
(16, 2, 'preferred_date', 'Preferred Date', NULL, 'date', 1, NULL, 7, 'enabled', 1, 1, '2026-05-01 17:38:22', '2026-05-01 17:38:22', NULL),
(17, 2, 'preferred_time', 'Preferred Time To Call', NULL, 'radio', 1, '{\n    \"Morning\": \"Morning\",\n    \"Afternoon\": \"Afternoon\",\n    \"Evening\": \"Evening\"\n}', 8, 'enabled', 1, 1, '2026-05-01 17:38:22', '2026-05-01 17:38:22', NULL),
(18, 2, 'message', 'Message / Concerns', 'Tell us how we can help...', 'textarea', 1, NULL, 9, 'enabled', 1, 1, '2026-05-01 17:38:22', '2026-05-01 17:38:22', NULL),
(19, 3, 'select_location', 'Select Location', NULL, 'select', 1, NULL, 1, 'enabled', 1, 1, '2026-05-02 17:38:22', '2026-05-02 17:38:22', NULL),
(20, 3, 'full_name', 'Full Name', 'John Doe', 'text', 1, NULL, 2, 'enabled', 1, 1, '2026-05-02 17:38:22', '2026-05-02 17:38:22', NULL),
(21, 3, 'phone_number', 'Phone Number', '+1 (555) 000-0000', 'text', 1, NULL, 3, 'enabled', 1, 1, '2026-05-02 17:38:22', '2026-05-02 17:38:22', NULL),
(22, 3, 'email_address', 'Email Address', 'john@example.com', 'email', 1, NULL, 4, 'enabled', 1, 1, '2026-05-02 17:38:22', '2026-05-02 17:38:22', NULL),
(23, 3, 'service_type', 'Service Type', NULL, 'select', 1, '{\n    \"Dental Treatment\": \"Dental Treatment\",\n    \"CDPC Patient\": \"CDPC Patient\",\n    \"Feedback\": \"Feedback\"\n, \n    \"Others\": \"Others\"\n}', 5, 'enabled', 1, 1, '2026-05-02 17:38:22', '2026-05-02 17:38:22', NULL),
(24, 3, 'comments', 'Comments', 'Tell us about your dental goals or any concerns...', 'textarea', 1, NULL, 6, 'enabled', 1, 1, '2026-05-02 17:38:22', '2026-05-02 17:38:22', NULL),
(25, 4, 'title', 'Title', NULL, 'radio', 0, '{\n    \"Mr.\": \"Mr.\",\n    \"Ms.\": \"Ms.\",\n    \"Mrs.\": \"Mrs.\"\n}', 1, 'enabled', 1, 1, '2026-05-12 17:38:22', '2026-05-12 17:38:22', NULL),
(26, 4, 'full_name', 'Full Name', 'John Doe', 'text', 1, NULL, 2, 'enabled', 1, 1, '2026-05-12 17:38:22', '2026-05-12 17:38:22', NULL),
(27, 4, 'age', 'Age', NULL, 'text', 1, NULL, 73, 'enabled', 1, 1, '2026-05-12 17:38:22', '2026-05-12 17:38:22', NULL),
(28, 4, 'sex', 'Sex', NULL, 'radio', 1, '{\n    \"Male\": \"Male\",\n    \"Female\": \"Female\", \n    \"Others\": \"Others\"\n}', 4, 'enabled', 1, 1, '2026-05-12 17:38:22', '2026-05-12 17:38:22', NULL),
(29, 4, 'marital_status', 'Marital Status', NULL, 'radio', 1, '{\n    \"Single\": \"Single\",\n    \"Married\": \"Married\", \n    \"Prefer Not to Say\": \"Prefer Not to Say\"\n}', 5, 'enabled', 1, 1, '2026-05-12 17:38:22', '2026-05-12 17:38:22', NULL),
(30, 4, 'date_of_birth', 'Date of Birth', NULL, 'text', 1, NULL, 6, 'enabled', 1, 1, '2026-05-12 17:38:22', '2026-05-12 17:38:22', NULL),
(31, 4, 'street_address', 'Street Address', NULL, 'text', 1, NULL, 7, 'enabled', 1, 1, '2026-05-12 17:38:22', '2026-05-12 17:38:22', NULL),
(32, 4, 'city', 'City', NULL, 'text', 1, NULL, 8, 'enabled', 1, 1, '2026-05-12 17:38:22', '2026-05-12 17:38:22', NULL),
(33, 4, 'province', 'Province / State', NULL, 'text', 1, NULL, 9, 'enabled', 1, 1, '2026-05-12 17:38:22', '2026-05-12 17:38:22', NULL),
(34, 4, 'postal_code', 'Postal Code', NULL, 'text', 1, NULL, 10, 'enabled', 1, 1, '2026-05-12 17:38:22', '2026-05-12 17:38:22', NULL),
(35, 4, 'email_address', 'Email Address', 'john@example.com', 'email', 1, NULL, 11, 'enabled', 1, 1, '2026-05-12 17:38:22', '2026-05-12 17:38:22', NULL),
(36, 4, 'home_phone', 'Home Phone', NULL, 'text', 0, NULL, 12, 'enabled', 1, 1, '2026-05-12 17:38:22', '2026-05-12 17:38:22', NULL),
(37, 4, 'cell_phone', 'Cell Phone', '+1 (555) 000-0000', 'text', 1, NULL, 13, 'enabled', 1, 1, '2026-05-12 17:38:22', '2026-05-12 17:38:22', NULL),
(38, 4, 'cccupation', 'Occupation', NULL, 'text', 0, NULL, 14, 'enabled', 1, 1, '2026-05-12 17:38:22', '2026-05-12 17:38:22', NULL),
(39, 4, 'employed_by', 'Employed By', NULL, 'text', 0, NULL, 15, 'enabled', 1, 1, '2026-05-12 17:38:22', '2026-05-12 17:38:22', NULL),
(40, 4, 'dental_insurance', 'Do you have Dental Insurance?', NULL, 'radio', 0, '{\n    \"Yes\": \"Yes\",\n    \"No\": \"No\"\n}', 16, 'enabled', 1, 1, '2026-05-12 17:38:22', '2026-05-12 17:38:22', NULL),
(41, 4, 'insurance_company', 'Insurance Company', NULL, 'text', 0, NULL, 17, 'enabled', 1, 1, '2026-05-12 17:38:22', '2026-05-12 17:38:22', NULL),
(42, 4, 'policy_no', 'Policy No.', NULL, 'text', 0, NULL, 18, 'enabled', 1, 1, '2026-05-12 17:38:22', '2026-05-12 17:38:22', NULL),
(43, 4, 'certificate_no', 'ID / Certificate No.', NULL, 'text', 0, NULL, 19, 'enabled', 1, 1, '2026-05-12 17:38:22', '2026-05-12 17:38:22', NULL),
(44, 4, 'family_physician', 'Family Physician', NULL, 'text', 0, NULL, 20, 'enabled', 1, 1, '2026-05-12 17:38:22', '2026-05-12 17:38:22', NULL),
(45, 4, 'physician_phone', 'Physician Phone', NULL, 'text', 0, NULL, 21, 'enabled', 1, 1, '2026-05-12 17:38:22', '2026-05-12 17:38:22', NULL),
(46, 4, 'previous_dentist', 'Previous Dentist', NULL, 'text', 0, NULL, 22, 'enabled', 1, 1, '2026-05-12 17:38:22', '2026-05-12 17:38:22', NULL),
(47, 4, 'previous_dentist_phone', 'Previous Dentist Phone', NULL, 'text', 0, NULL, 23, 'enabled', 1, 1, '2026-05-12 17:38:22', '2026-05-12 17:38:22', NULL),
(48, 4, 'referral_credit', 'Referral Credit (Whom May We Thank For Referring You?)', NULL, 'text', 0, NULL, 24, 'enabled', 1, 1, '2026-05-12 17:38:22', '2026-05-12 17:38:22', NULL),
(49, 4, 'en_contact_name', 'Contact Name', 'Contact Name', 'text', 0, NULL, 25, 'enabled', 1, 1, '2026-05-12 17:38:22', '2026-05-12 17:38:22', NULL),
(50, 4, 'en_relationship', 'Relationship', 'Relationship', 'text', 0, NULL, 26, 'enabled', 1, 1, '2026-05-12 17:38:22', '2026-05-12 17:38:22', NULL),
(51, 4, 'en_address', 'Address', 'Address', 'text', 0, NULL, 27, 'enabled', 1, 1, '2026-05-12 17:38:22', '2026-05-12 17:38:22', NULL),
(52, 4, 'en_phone_number', 'Phone Number', 'Phone Number', 'text', 0, NULL, 28, 'enabled', 1, 1, '2026-05-12 17:38:22', '2026-05-12 17:38:22', NULL),
(53, 4, 'dlcp_examination', '1. Date of last complete physical examination', NULL, 'text', 0, NULL, 29, 'enabled', 1, 1, '2026-05-12 17:38:22', '2026-05-12 17:38:22', NULL),
(54, 4, 'cup_care', '2. Are you currently under a physician’s care?', NULL, 'radio', 0, '{\n    \"Yes\": \"Yes\",\n    \"No\": \"No\"\n}', 30, 'enabled', 1, 1, '2026-05-12 17:38:22', '2026-05-12 17:38:22', NULL),
(55, 4, 'cup_care_specify', 'If yes, specify', 'If yes, specify', 'text', 0, NULL, 31, 'enabled', 1, 1, '2026-05-12 17:38:22', '2026-05-12 17:38:22', NULL),
(56, 4, 'frequent_headaches', '3. Do you have frequent headaches?', NULL, 'radio', 0, '{\n    \"Yes\": \"Yes\",\n    \"No\": \"No\"\n}', 32, 'enabled', 1, 1, '2026-05-12 17:38:22', '2026-05-12 17:38:22', NULL),
(57, 4, 'smoke', '4. Do you smoke?', NULL, 'radio', 0, '{\n    \"Yes\": \"Yes\",\n    \"No\": \"No\"\n}', 33, 'enabled', 1, 1, '2026-05-12 17:38:22', '2026-05-12 17:38:22', NULL),
(58, 4, 'drink_alcohol', '5. Do you drink alcohol?', NULL, 'radio', 0, '{\n    \"Yes\": \"Yes\",\n    \"No\": \"No\"\n}', 34, 'enabled', 1, 1, '2026-05-12 17:38:22', '2026-05-12 17:38:22', NULL),
(59, 4, 'drink_alcohol_specify', 'If yes how much?', 'If yes how much?', 'text', 0, NULL, 35, 'enabled', 1, 1, '2026-05-12 17:38:22', '2026-05-12 17:38:22', NULL),
(60, 4, 'recreational_drugs', '6. Do you do recreational drugs?', NULL, 'radio', 0, '{\n    \"Yes\": \"Yes\",\n    \"No\": \"No\"\n}', 36, 'enabled', 1, 1, '2026-05-12 17:38:22', '2026-05-12 17:38:22', NULL),
(61, 4, 'herbal_substances', '7. Do you routinely take vitamins, herbal substances, or natural products?', NULL, 'radio', 0, '{\n    \"Yes\": \"Yes\",\n    \"No\": \"No\"\n}', 37, 'enabled', 1, 1, '2026-05-12 17:38:22', '2026-05-12 17:38:22', NULL),
(62, 4, 'herbal_substances_specify', 'If yes please list', 'If yes please list', 'text', 0, NULL, 38, 'enabled', 1, 1, '2026-05-12 17:38:22', '2026-05-12 17:38:22', NULL),
(63, 4, 'any_medications', '8. Are you taking any medications?', NULL, 'radio', 0, '{\n    \"Yes\": \"Yes\",\n    \"No\": \"No\"\n}', 39, 'enabled', 1, 1, '2026-05-12 17:38:22', '2026-05-12 17:38:22', NULL),
(64, 4, 'any_medications_specify', 'If yes please list', 'If yes please list', 'text', 0, NULL, 40, 'enabled', 1, 1, '2026-05-12 17:38:22', '2026-05-12 17:38:22', NULL),
(65, 4, 'prolonged_medication', '9. Have you taken any prolonged medication in the past?', NULL, 'radio', 0, '{\n    \"Yes\": \"Yes\",\n    \"No\": \"No\"\n}', 41, 'enabled', 1, 1, '2026-05-12 17:38:22', '2026-05-12 17:38:22', NULL),
(66, 4, 'prolonged_medication_specify', 'If yes, specify', 'If yes, specify', 'text', 0, NULL, 42, 'enabled', 1, 1, '2026-05-12 17:38:22', '2026-05-12 17:38:22', NULL),
(67, 4, 'cortisone', '10. Have you taken cortisone or steroids?', NULL, 'radio', 0, '{\n    \"Yes\": \"Yes\",\n    \"No\": \"No\"\n}', 43, 'enabled', 1, 1, '2026-05-12 17:38:22', '2026-05-12 17:38:22', NULL),
(68, 4, 'any_surgery', '11. Have you ever been hospitalized for any surgery?', NULL, 'radio', 0, '{\n    \"Yes\": \"Yes\",\n    \"No\": \"No\"\n}', 44, 'enabled', 1, 1, '2026-05-12 17:38:22', '2026-05-12 17:38:22', NULL),
(69, 4, 'any_surgery_specify', 'If yes, specify', 'If yes, specify', 'text', 0, NULL, 45, 'enabled', 1, 1, '2026-05-12 17:38:22', '2026-05-12 17:38:22', NULL),
(70, 4, 'ankles_swollen', '12. Are your ankles often swollen?', NULL, 'radio', 0, '{\n    \"Yes\": \"Yes\",\n    \"No\": \"No\"\n}', 46, 'enabled', 1, 1, '2026-05-12 17:38:22', '2026-05-12 17:38:22', NULL),
(71, 4, 'gained_lost_weight', '13. Have you gained or lost excessive weight recently?', NULL, 'radio', 0, '{\n    \"Yes\": \"Yes\",\n    \"No\": \"No\"\n}', 47, 'enabled', 1, 1, '2026-05-12 17:38:22', '2026-05-12 17:38:22', NULL),
(72, 4, 'pregnant', '14. Are you pregnant?', NULL, 'radio', 0, '{\n    \"Yes\": \"Yes\",\n    \"No\": \"No\"\n}', 48, 'enabled', 1, 1, '2026-05-12 17:38:22', '2026-05-12 17:38:22', NULL),
(73, 4, 'pregnant_weeks', 'If so, how many weeks?', 'If so, how many weeks?', 'text', 0, NULL, 49, 'enabled', 1, 1, '2026-05-12 17:38:22', '2026-05-12 17:38:22', NULL),
(74, 4, 'adverse_reaction', '15. Are you sensitive or have you ever had an adverse reaction to:', NULL, 'checkbox', 0, '{\n    \"Latex\": \"Latex\",\n    \"Penicillin\": \"Penicillin\"\n,    \"Metals\": \"Metals\",\n    \"Sulfa Drugs\": \"Sulfa Drugs\"\n}', 50, 'enabled', 1, 1, '2026-05-12 17:38:22', '2026-05-12 17:38:22', NULL),
(75, 4, 'allergic_adverse_reaction', '16. Are you allergic or have adverse reactions to:', NULL, 'checkbox', 0, '{\n    \"Aspirin\": \"Aspirin\",\n    \"Local Anesthetic (Freezing)\": \"Local Anesthetic (Freezing)\"\n,    \"Barbiturates (Sleeping pills)\": \"Barbiturates (Sleeping pills)\",\n    \"Nitrous Oxide\": \"Nitrous Oxide\"\n,    \"Codeine\": \"Codeine\"\n}', 51, 'enabled', 1, 1, '2026-05-12 17:38:22', '2026-05-12 17:38:22', NULL),
(76, 4, 'adverse_reactions', '17. Are you allergic or have adverse reactions to any other drugs?', NULL, 'radio', 0, '{\n    \"Yes\": \"Yes\",\n    \"No\": \"No\"\n}', 52, 'enabled', 1, 1, '2026-05-12 17:38:22', '2026-05-12 17:38:22', NULL),
(77, 4, 'adverse_reactions_specify', 'If yes please list', 'If yes please list', 'text', 0, NULL, 53, 'enabled', 1, 1, '2026-05-12 17:38:22', '2026-05-12 17:38:22', NULL),
(78, 4, 'treated', '18. Have you ever been treated for or told you have any of the following:', NULL, 'checkbox', 0, '{\n    \"COVID-19\": \"COVID-19\",\n    \"Heart Murmur\": \"Heart Murmur\"\n,    \"Arthritis\": \"Arthritis\",\n    \"Hepatitis B\": \"Hepatitis B\"\n,    \"Asthma\": \"Asthma\"\n,    \"HIV (AIDS)\": \"HIV (AIDS)\"\n,    \"Blood Disorder\": \"Blood Disorder\"\n,    \"Hypertension / Low BP\": \"Hypertension / Low BP\"\n,    \"Anemia\": \"Anemia\"\n,    \"Liver Disease\": \"Liver Disease\"\n,    \"Leukemia\": \"Leukemia\"\n,    \"Mental Disability\": \"Mental Disability\"\n,    \"Cardiovascular Disease\": \"Cardiovascular Disease\"\n,    \"Renal Disease\": \"Renal Disease\"\n,    \"Cancer\": \"Cancer\"\n,    \"Rheumatic Fever\": \"Rheumatic Fever\"\n,    \"Diabetes Type I / Type II\": \"Diabetes Type I / Type II\"\n,    \"Thyroid Disease\": \"Thyroid Disease\"\n,    \"Emphysema\": \"Emphysema\"\n,    \"Tuberculosis\": \"Tuberculosis\"\n,    \"Epilepsy\": \"Epilepsy\"\n,    \"Venereal Disease\": \"Venereal Disease\"\n}', 54, 'enabled', 1, 1, '2026-05-12 17:38:22', '2026-05-12 17:38:22', NULL),
(79, 4, 'heavy_bleeding', '19. Have you ever experienced heavy bleeding?', NULL, 'radio', 0, '{\n    \"Yes\": \"Yes\",\n    \"No\": \"No\"\n}', 55, 'enabled', 1, 1, '2026-05-12 17:38:22', '2026-05-12 17:38:22', NULL),
(80, 4, 'anything_else_know', '20. Is there anything else we should know?', NULL, 'radio', 0, '{\n    \"Yes\": \"Yes\",\n    \"No\": \"No\"\n}', 56, 'enabled', 1, 1, '2026-05-12 17:38:22', '2026-05-12 17:38:22', NULL),
(81, 4, 'anything_else_know_specify', 'If yes please list', 'If yes please list', 'text', 0, NULL, 57, 'enabled', 1, 1, '2026-05-12 17:38:22', '2026-05-12 17:38:22', NULL),
(82, 4, 'other_disease', '21. Have you been diagnosed with any other disease,<br>condition or problem not listed above?', NULL, 'radio', 0, '{\n    \"Yes\": \"Yes\",\n    \"No\": \"No\"\n}', 58, 'enabled', 1, 1, '2026-05-12 17:38:22', '2026-05-12 17:38:22', NULL),
(83, 4, 'anything_about_health', '22. Is there anything about your health we should be aware of?', NULL, 'radio', 0, '{\n    \"Yes\": \"Yes\",\n    \"No\": \"No\"\n}', 59, 'enabled', 1, 1, '2026-05-12 17:38:22', '2026-05-12 17:38:22', NULL),
(84, 4, 'anything_about_health_specify', 'If yes please list', 'If yes please list', 'text', 0, NULL, 60, 'enabled', 1, 1, '2026-05-12 17:38:22', '2026-05-12 17:38:22', NULL),
(85, 4, 'speak_doctor_privately', '23. Do you wish to speak to the doctor privately about any problem or medical condition(s)?', NULL, 'radio', 0, '{\n    \"Yes\": \"Yes\",\n    \"No\": \"No\"\n}', 61, 'enabled', 1, 1, '2026-05-12 17:38:22', '2026-05-12 17:38:22', NULL),
(86, 4, 'date_last_complete_exam', '24. Date of last complete exam', NULL, 'text', 0, NULL, 62, 'enabled', 1, 1, '2026-05-12 17:38:22', '2026-05-12 17:38:22', NULL),
(87, 4, 'date_last_cleaning', '25. Date of last cleaning', NULL, 'text', 0, NULL, 63, 'enabled', 1, 1, '2026-05-12 17:38:22', '2026-05-12 17:38:22', NULL),
(88, 4, 'date_last_x_rays', '26. Date of last x-rays', NULL, 'text', 0, NULL, 64, 'enabled', 1, 1, '2026-05-12 17:38:22', '2026-05-12 17:38:22', NULL),
(89, 4, 'last_dentist_regularly', '27. Did you see your last dentist regularly?', NULL, 'radio', 0, '{\n    \"Yes\": \"Yes\",\n    \"No\": \"No\"\n}', 65, 'enabled', 1, 1, '2026-05-12 17:38:22', '2026-05-12 17:38:22', NULL),
(90, 4, 'last_dentist', '28. How often did you see your last dentist?', 'How often?', 'text', 0, NULL, 66, 'enabled', 1, 1, '2026-05-12 17:38:22', '2026-05-12 17:38:22', NULL),
(91, 4, 'last_dentist_description', 'What was done at that time?', 'Description', 'text', 0, NULL, 67, 'enabled', 1, 1, '2026-05-12 17:38:22', '2026-05-12 17:38:22', NULL),
(92, 4, 'antibiotics', '29. Have you ever been advised to take antibiotics before a dental treatment?', NULL, 'radio', 0, '{\n    \"Yes\": \"Yes\",\n    \"No\": \"No\"\n}', 68, 'enabled', 1, 1, '2026-05-12 17:38:22', '2026-05-12 17:38:22', NULL),
(93, 4, 'heavy_bleeding_extractions', '30. Have you ever experienced difficulty or heavy bleeding following extractions?', NULL, 'radio', 0, '{\n    \"Yes\": \"Yes\",\n    \"No\": \"No\"\n}', 69, 'enabled', 1, 1, '2026-05-12 17:38:22', '2026-05-12 17:38:22', NULL),
(94, 4, 'gum_treatment', '31. Have you ever had gum treatment or surgery?', NULL, 'radio', 0, '{\n    \"Yes\": \"Yes\",\n    \"No\": \"No\"\n}', 70, 'enabled', 1, 1, '2026-05-12 17:38:22', '2026-05-12 17:38:22', NULL),
(95, 4, 'orthodontic_treatment', '32. Have you had any orthodontic treatment?', NULL, 'radio', 0, '{\n    \"Yes\": \"Yes\",\n    \"No\": \"No\"\n}', 71, 'enabled', 1, 1, '2026-05-12 17:38:22', '2026-05-12 17:38:22', NULL),
(96, 4, 'unpleasant_dental_experience', '33. Have you ever had an unpleasant dental experience?', NULL, 'radio', 0, '{\n    \"Yes\": \"Yes\",\n    \"No\": \"No\"\n}', 72, 'enabled', 1, 1, '2026-05-12 17:38:22', '2026-05-12 17:38:22', NULL),
(97, 4, 'pleasant_dental_experience', '34. How can we make your dental experience more pleasant?', NULL, 'text', 0, NULL, 73, 'enabled', 1, 1, '2026-05-12 17:38:22', '2026-05-12 17:38:22', NULL),
(98, 4, 'anything_else_should_know', '35. Is there anything else we should know?', NULL, 'text', 0, NULL, 74, 'enabled', 1, 1, '2026-05-12 17:38:22', '2026-05-12 17:38:22', NULL),
(99, 4, 'brings_office_today', '36. What brings you to the office today?', NULL, 'text', 0, NULL, 75, 'enabled', 1, 1, '2026-05-12 17:38:22', '2026-05-12 17:38:22', NULL),
(100, 4, 'any_discomfort', '37. Are you in any discomfort?', NULL, 'radio', 0, '{\n    \"Yes\": \"Yes\",\n    \"No\": \"No\"\n}', 76, 'enabled', 1, 1, '2026-05-12 17:38:22', '2026-05-12 17:38:22', NULL),
(101, 4, 'any_discomfort_specify', 'If yes, specify', 'If yes, specify', 'text', 0, NULL, 77, 'enabled', 1, 1, '2026-05-12 17:38:22', '2026-05-12 17:38:22', NULL),
(102, 4, 'have_experienced', '38. Do you have or have you experienced:', NULL, 'checkbox', 0, '{\n    \"Tooth sensitivity\": \"Tooth sensitivity\",\n    \"Bad breath\": \"Bad breath\"\n,    \"Ear ache\": \"Ear ache\",\n    \"Headaches\": \"Headaches\"\n,    \"Bleeding gums\": \"Bleeding gums\"\n,    \"Sore gums\": \"Sore gums\"\n,    \"Gagging\": \"Gagging\"\n,    \"Missing teeth\": \"Missing teeth\"\n,    \"Loose Teeth\": \"Loose Teeth\"\n,    \"Spaced or Crooked teeth\": \"Spaced or Crooked teeth\"\n,    \"Unexplained nosebleed\": \"Unexplained nosebleed\"\n,    \"Unsatisfactory dentures\": \"Unsatisfactory dentures\"\n,    \"Difficulty opening or closing\": \"Difficulty opening or closing\"\n,    \"Lump or swelling in your mouth\": \"Lump or swelling in your mouth\"\n,    \"Clench or Grind\": \"Clench or Grind\"\n,    \"Neck pain\": \"Neck pain\"\n,    \"Popping or clicking in the jaw joints\": \"Popping or clicking in the jaw joints\"\n,    \"Thyroid Disease\": \"Thyroid Disease\"\n,    \"Emphysema\": \"Emphysema\"\n,    \"Tuberculosis\": \"Tuberculosis\"\n,    \"Epilepsy\": \"Epilepsy\"\n,    \"Venereal Disease\": \"Venereal Disease\"\n}', 78, 'enabled', 1, 1, '2026-05-12 17:38:22', '2026-05-12 17:38:22', NULL),
(103, 4, 'food_teeth', '39. Does food get caught between your teeth?', NULL, 'radio', 0, '{\n    \"Yes\": \"Yes\",\n    \"No\": \"No\"\n}', 79, 'enabled', 1, 1, '2026-05-12 17:38:22', '2026-05-12 17:38:22', NULL),
(104, 4, 'sore_spots', '40. Do you have any sore spots in your mouth?', NULL, 'radio', 0, '{\n    \"Yes\": \"Yes\",\n    \"No\": \"No\"\n}', 80, 'enabled', 1, 1, '2026-05-12 17:38:22', '2026-05-12 17:38:22', NULL),
(105, 4, 'teeth_replaced', '41. Have you had any teeth replaced?', NULL, 'radio', 0, '{\n    \"Yes\": \"Yes\",\n    \"No\": \"No\"\n}', 81, 'enabled', 1, 1, '2026-05-12 17:38:22', '2026-05-12 17:38:22', NULL),
(106, 4, 'permanent_tooth_replacement', '42. Would you like to learn more about permanent tooth replacement?', NULL, 'radio', 0, '{\n    \"Yes\": \"Yes\",\n    \"No\": \"No\"\n}', 82, 'enabled', 1, 1, '2026-05-12 17:38:22', '2026-05-12 17:38:22', NULL),
(107, 4, 'local_anesthesia', '43. Have you ever been given local anesthesia (Freezing)?', NULL, 'radio', 0, '{\n    \"Yes\": \"Yes\",\n    \"No\": \"No\"\n}', 83, 'enabled', 1, 1, '2026-05-12 17:38:22', '2026-05-12 17:38:22', NULL),
(108, 4, 'general_anesthesia', '44. Have you ever been given general anesthesia?', NULL, 'radio', 0, '{\n    \"Yes\": \"Yes\",\n    \"No\": \"No\"\n}', 84, 'enabled', 1, 1, '2026-05-12 17:38:22', '2026-05-12 17:38:22', NULL),
(109, 4, 'satisfied_appearance_teeth', '45. Are you satisfied with the appearance of your teeth?', NULL, 'radio', 0, '{\n    \"Yes\": \"Yes\",\n    \"No\": \"No\"\n}', 85, 'enabled', 1, 1, '2026-05-12 17:38:22', '2026-05-12 17:38:22', NULL),
(110, 4, 'keep_natural_teeth', '46. Are you anxious to keep your natural teeth?', NULL, 'radio', 0, '{\n    \"Yes\": \"Yes\",\n    \"No\": \"No\"\n}', 86, 'enabled', 1, 1, '2026-05-12 17:38:22', '2026-05-12 17:38:22', NULL),
(111, 4, 'tense_dental_visits', '47. Are you tense during dental visits?', NULL, 'radio', 0, '{\n    \"Yes\": \"Yes\",\n    \"No\": \"No\"\n}', 87, 'enabled', 1, 1, '2026-05-12 17:38:22', '2026-05-12 17:38:22', NULL),
(112, 4, 'calm_nerves', '48. Are you interested in a method to calm your nerves during dental visits?', NULL, 'radio', 0, '{\n    \"Yes\": \"Yes\",\n    \"No\": \"No\"\n}', 88, 'enabled', 1, 1, '2026-05-12 17:38:22', '2026-05-12 17:38:22', NULL),
(113, 4, 'describe', '49. Describe in your own words, how can we help you today?', 'Share your dental goals or concerns...', 'textarea', 1, NULL, 89, 'enabled', 1, 1, '2026-05-12 17:38:22', '2026-05-12 17:38:22', NULL),
(114, 4, 'signature', 'Signature', NULL, 'signature', 1, NULL, 90, 'enabled', 1, 1, '2026-05-12 17:38:22', '2026-05-12 17:38:22', NULL),
(115, 4, 'print_name', 'Print Name', 'John Doe', 'text', 0, NULL, 91, 'enabled', 1, 1, '2026-05-12 17:38:22', '2026-05-12 17:38:22', NULL),
(116, 4, 'location', 'Location', NULL, 'hidden', 0, NULL, 92, 'enabled', 1, 1, '2026-05-12 17:38:22', '2026-05-12 17:38:22', NULL),
(117, 4, 'consent_privacy_patient', 'I agreed that CHAGGER DENTISTRY PROFESSIONAL CORPORATION or CHAGGER AFFILIATES can collect, use and disclose personal information about ___________________ as set out above in the information about the office’s privacy policies.', NULL, 'checkbox', 1, NULL, 94, 'enabled', 1, 1, '2026-05-12 17:38:22', '2026-05-12 17:38:22', NULL),
(118, 4, 'privacy_patient_name', 'Privacy Patient Name', 'John Doe', 'text', 0, NULL, 95, 'enabled', 1, 1, '2026-05-12 17:38:22', '2026-05-12 17:38:22', NULL),
(119, 4, 'consent_newsletter', 'I agree to receive CHAGGER DENTAL EMAILS, TEXTS, UPDATES AND PROMOTION REGARDING CHAGGER DENTAL’S SERVICES. I confirm that I can withdraw my consent at any time.', NULL, 'checkbox', 0, NULL, 96, 'enabled', 1, 1, '2026-05-12 17:38:22', '2026-05-12 17:38:22', NULL);

-- --------------------------------------------------------

--
-- Table structure for table `cdt_form_submissions`
--

CREATE TABLE `cdt_form_submissions` (
  `id` bigint UNSIGNED NOT NULL,
  `form_id` bigint NOT NULL,
  `file_name` varchar(255) COLLATE utf8mb4_unicode_ci DEFAULT NULL,
  `user_ip` varchar(255) COLLATE utf8mb4_unicode_ci DEFAULT NULL,
  `user_agent` varchar(255) COLLATE utf8mb4_unicode_ci DEFAULT NULL,
  `browser` varchar(255) COLLATE utf8mb4_unicode_ci DEFAULT NULL,
  `platform` varchar(255) COLLATE utf8mb4_unicode_ci DEFAULT NULL,
  `status` enum('New','Read','Archived','Migrated') COLLATE utf8mb4_unicode_ci NOT NULL DEFAULT 'New',
  `created_id` int NOT NULL DEFAULT '0',
  `updated_id` int NOT NULL DEFAULT '0',
  `created_at` timestamp NULL DEFAULT NULL,
  `updated_at` timestamp NULL DEFAULT NULL
) ENGINE=InnoDB DEFAULT CHARSET=utf8mb4 COLLATE=utf8mb4_unicode_ci;

--
-- Dumping data for table `cdt_form_submissions`
--

INSERT INTO `cdt_form_submissions` (`id`, `form_id`, `file_name`, `user_ip`, `user_agent`, `browser`, `platform`, `status`, `created_id`, `updated_id`, `created_at`, `updated_at`) VALUES
(1, 1, NULL, '172.18.0.1', 'Mozilla/5.0 (Windows NT 10.0; Win64; x64) AppleWebKit/537.36 (KHTML, like Gecko) Chrome/147.0.0.0 Safari/537.36', 'Chrome', 'Windows', 'New', 0, 0, '2026-05-01 12:33:04', '2026-05-01 12:33:04'),
(2, 1, NULL, '172.18.0.1', 'Mozilla/5.0 (Windows NT 10.0; Win64; x64) AppleWebKit/537.36 (KHTML, like Gecko) Chrome/147.0.0.0 Safari/537.36', 'Chrome', 'Windows', 'New', 0, 0, '2026-05-01 13:11:28', '2026-05-01 13:11:28'),
(3, 1, NULL, '172.18.0.1', 'Mozilla/5.0 (Windows NT 10.0; Win64; x64) AppleWebKit/537.36 (KHTML, like Gecko) Chrome/147.0.0.0 Safari/537.36', 'Chrome', 'Windows', 'New', 0, 0, '2026-05-02 00:07:17', '2026-05-02 00:07:17'),
(4, 1, NULL, '172.18.0.1', 'Mozilla/5.0 (Windows NT 10.0; Win64; x64) AppleWebKit/537.36 (KHTML, like Gecko) Chrome/147.0.0.0 Safari/537.36', 'Chrome', 'Windows', 'New', 0, 0, '2026-05-02 01:06:36', '2026-05-02 01:06:36'),
(5, 2, NULL, '172.18.0.1', 'Mozilla/5.0 (Windows NT 10.0; Win64; x64) AppleWebKit/537.36 (KHTML, like Gecko) Chrome/147.0.0.0 Safari/537.36', 'Chrome', 'Windows', 'New', 0, 0, '2026-05-02 02:34:39', '2026-05-02 02:34:39'),
(6, 2, NULL, '172.18.0.1', 'Mozilla/5.0 (Windows NT 10.0; Win64; x64) AppleWebKit/537.36 (KHTML, like Gecko) Chrome/147.0.0.0 Safari/537.36', 'Chrome', 'Windows', 'New', 0, 0, '2026-05-02 02:37:46', '2026-05-02 02:37:46'),
(7, 2, NULL, '172.18.0.1', 'Mozilla/5.0 (Windows NT 10.0; Win64; x64) AppleWebKit/537.36 (KHTML, like Gecko) Chrome/147.0.0.0 Safari/537.36', 'Chrome', 'Windows', 'New', 0, 0, '2026-05-02 02:38:53', '2026-05-02 02:38:53'),
(8, 2, NULL, '172.18.0.1', 'Mozilla/5.0 (Windows NT 10.0; Win64; x64) AppleWebKit/537.36 (KHTML, like Gecko) Chrome/147.0.0.0 Safari/537.36', 'Chrome', 'Windows', 'New', 0, 0, '2026-05-02 03:42:35', '2026-05-02 03:42:35'),
(9, 2, NULL, '172.18.0.1', 'Mozilla/5.0 (Windows NT 10.0; Win64; x64) AppleWebKit/537.36 (KHTML, like Gecko) Chrome/147.0.0.0 Safari/537.36', 'Chrome', 'Windows', 'New', 0, 0, '2026-05-02 08:49:42', '2026-05-02 08:49:42'),
(10, 2, NULL, '172.18.0.1', 'Mozilla/5.0 (Windows NT 10.0; Win64; x64) AppleWebKit/537.36 (KHTML, like Gecko) Chrome/147.0.0.0 Safari/537.36', 'Chrome', 'Windows', 'New', 0, 0, '2026-05-02 09:25:13', '2026-05-02 09:25:13'),
(11, 2, NULL, '172.18.0.1', 'Mozilla/5.0 (Windows NT 10.0; Win64; x64) AppleWebKit/537.36 (KHTML, like Gecko) Chrome/147.0.0.0 Safari/537.36', 'Chrome', 'Windows', 'New', 0, 0, '2026-05-02 09:32:58', '2026-05-02 09:32:58'),
(12, 3, NULL, '172.18.0.1', 'Mozilla/5.0 (Windows NT 10.0; Win64; x64) AppleWebKit/537.36 (KHTML, like Gecko) Chrome/147.0.0.0 Safari/537.36', 'Chrome', 'Windows', 'New', 0, 0, '2026-05-02 10:54:02', '2026-05-02 10:54:02'),
(13, 3, NULL, '172.18.0.1', 'Mozilla/5.0 (Windows NT 10.0; Win64; x64) AppleWebKit/537.36 (KHTML, like Gecko) Chrome/147.0.0.0 Safari/537.36', 'Chrome', 'Windows', 'New', 0, 0, '2026-05-02 11:07:17', '2026-05-02 11:07:17'),
(24, 4, 'new_patient_form_24_1778832685.pdf', '172.18.0.1', 'Mozilla/5.0 (Windows NT 10.0; Win64; x64) AppleWebKit/537.36 (KHTML, like Gecko) Chrome/148.0.0.0 Safari/537.36', 'Chrome', 'Windows', 'New', 0, 0, '2026-05-15 04:11:25', '2026-05-15 04:11:26'),
(25, 4, 'new_patient_form_25_1778833696.pdf', '172.18.0.1', 'Mozilla/5.0 (Windows NT 10.0; Win64; x64) AppleWebKit/537.36 (KHTML, like Gecko) Chrome/148.0.0.0 Safari/537.36', 'Chrome', 'Windows', 'New', 0, 0, '2026-05-15 04:28:15', '2026-05-15 04:28:17'),
(26, 4, 'new_patient_form_26_1778901936.pdf', '172.18.0.1', 'Mozilla/5.0 (Windows NT 10.0; Win64; x64) AppleWebKit/537.36 (KHTML, like Gecko) Chrome/148.0.0.0 Safari/537.36', 'Chrome', 'Windows', 'New', 0, 0, '2026-05-15 23:25:35', '2026-05-15 23:25:38'),
(27, 4, 'new_patient_form_27_1778911875.pdf', '172.18.0.1', 'Mozilla/5.0 (Windows NT 10.0; Win64; x64) AppleWebKit/537.36 (KHTML, like Gecko) Chrome/148.0.0.0 Safari/537.36', 'Chrome', 'Windows', 'New', 0, 0, '2026-05-16 02:11:14', '2026-05-16 02:11:16'),
(28, 4, 'new_patient_form_28_1778913793.pdf', '172.18.0.1', 'Mozilla/5.0 (Windows NT 10.0; Win64; x64) AppleWebKit/537.36 (KHTML, like Gecko) Chrome/148.0.0.0 Safari/537.36', 'Chrome', 'Windows', 'New', 0, 0, '2026-05-16 02:43:13', '2026-05-16 02:43:14'),
(29, 4, 'new_patient_form_29_1778914665.pdf', '172.18.0.1', 'Mozilla/5.0 (Windows NT 10.0; Win64; x64) AppleWebKit/537.36 (KHTML, like Gecko) Chrome/148.0.0.0 Safari/537.36', 'Chrome', 'Windows', 'New', 0, 0, '2026-05-16 02:57:45', '2026-05-16 02:57:46'),
(30, 4, 'new_patient_form_30_1779099745.pdf', '172.18.0.1', 'Mozilla/5.0 (Windows NT 10.0; Win64; x64) AppleWebKit/537.36 (KHTML, like Gecko) Chrome/148.0.0.0 Safari/537.36', 'Chrome', 'Windows', 'New', 0, 0, '2026-05-18 06:22:24', '2026-05-18 06:22:26'),
(31, 4, NULL, '172.18.0.1', 'Mozilla/5.0 (Windows NT 10.0; Win64; x64) AppleWebKit/537.36 (KHTML, like Gecko) Chrome/148.0.0.0 Safari/537.36', 'Chrome', 'Windows', 'New', 0, 0, '2026-05-18 06:32:38', '2026-05-18 06:32:38'),
(32, 4, 'new_patient_form_32_1779100617.pdf', '172.18.0.1', 'Mozilla/5.0 (Windows NT 10.0; Win64; x64) AppleWebKit/537.36 (KHTML, like Gecko) Chrome/148.0.0.0 Safari/537.36', 'Chrome', 'Windows', 'New', 0, 0, '2026-05-18 06:36:56', '2026-05-18 06:36:58'),
(33, 4, 'new_patient_form_33_1779101794.pdf', '172.18.0.1', 'Mozilla/5.0 (Windows NT 10.0; Win64; x64) AppleWebKit/537.36 (KHTML, like Gecko) Chrome/148.0.0.0 Safari/537.36', 'Chrome', 'Windows', 'New', 0, 0, '2026-05-18 06:56:33', '2026-05-18 06:56:34'),
(34, 4, 'new_patient_form_34_1779102980.pdf', '172.18.0.1', 'Mozilla/5.0 (Windows NT 10.0; Win64; x64) AppleWebKit/537.36 (KHTML, like Gecko) Chrome/148.0.0.0 Safari/537.36', 'Chrome', 'Windows', 'New', 0, 0, '2026-05-18 07:16:19', '2026-05-18 07:16:21'),
(35, 4, 'new_patient_form_35_1779104401.pdf', '172.18.0.1', 'Mozilla/5.0 (Windows NT 10.0; Win64; x64) AppleWebKit/537.36 (KHTML, like Gecko) Chrome/148.0.0.0 Safari/537.36', 'Chrome', 'Windows', 'New', 0, 0, '2026-05-18 07:40:00', '2026-05-18 07:40:02'),
(36, 4, 'new_patient_form_36_1779105215.pdf', '172.18.0.1', 'Mozilla/5.0 (Windows NT 10.0; Win64; x64) AppleWebKit/537.36 (KHTML, like Gecko) Chrome/148.0.0.0 Safari/537.36', 'Chrome', 'Windows', 'New', 0, 0, '2026-05-18 07:53:34', '2026-05-18 07:53:36'),
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(40, 4, 'new_patient_form_40_1779109326.pdf', '172.18.0.1', 'Mozilla/5.0 (Windows NT 10.0; Win64; x64) AppleWebKit/537.36 (KHTML, like Gecko) Chrome/148.0.0.0 Safari/537.36', 'Chrome', 'Windows', 'New', 0, 0, '2026-05-18 09:02:05', '2026-05-18 09:02:07'),
(41, 4, 'new_patient_form_41_1779113032.pdf', '172.18.0.1', 'Mozilla/5.0 (Windows NT 10.0; Win64; x64) AppleWebKit/537.36 (KHTML, like Gecko) Chrome/148.0.0.0 Safari/537.36', 'Chrome', 'Windows', 'New', 0, 0, '2026-05-18 10:03:51', '2026-05-18 10:03:53');

-- --------------------------------------------------------

--
-- Table structure for table `cdt_form_submission_values`
--

CREATE TABLE `cdt_form_submission_values` (
  `id` bigint UNSIGNED NOT NULL,
  `submission_id` bigint NOT NULL,
  `field_name` varchar(255) COLLATE utf8mb4_unicode_ci NOT NULL,
  `field_value` longtext COLLATE utf8mb4_unicode_ci,
  `created_at` timestamp NULL DEFAULT NULL,
  `updated_at` timestamp NULL DEFAULT NULL
) ENGINE=InnoDB DEFAULT CHARSET=utf8mb4 COLLATE=utf8mb4_unicode_ci;

--
-- Dumping data for table `cdt_form_submission_values`
--

INSERT INTO `cdt_form_submission_values` (`id`, `submission_id`, `field_name`, `field_value`, `created_at`, `updated_at`) VALUES
(1, 1, 'preferred_location', 'Burlington', '2026-05-01 12:33:04', '2026-05-01 12:33:04'),
(2, 1, 'services', 'General Consultation', '2026-05-01 12:33:04', '2026-05-01 12:33:04'),
(3, 1, 'full_name', 'Vikash Kumar', '2026-05-01 12:33:04', '2026-05-01 12:33:04'),
(4, 1, 'phone_number', '416-578-0907', '2026-05-01 12:33:04', '2026-05-01 12:33:04'),
(5, 1, 'email_address', 'vikash@tastechnologies.com', '2026-05-01 12:33:04', '2026-05-01 12:33:04'),
(6, 1, 'address', '1155 North Service Rd W Suite 11', '2026-05-01 12:33:04', '2026-05-01 12:33:04'),
(7, 1, 'preferred_date', '2026-05-08', '2026-05-01 12:33:04', '2026-05-01 12:33:04'),
(8, 1, 'preferred_time', 'Afternoon', '2026-05-01 12:33:04', '2026-05-01 12:33:04'),
(9, 1, 'message', 'Just for testing purpose, please ignore it.', '2026-05-01 12:33:04', '2026-05-01 12:33:04'),
(10, 2, 'preferred_location', 'Mississauga', '2026-05-01 13:11:28', '2026-05-01 13:11:28'),
(11, 2, 'services', 'Cosmetic Dentistry', '2026-05-01 13:11:28', '2026-05-01 13:11:28'),
(12, 2, 'full_name', 'Vikash Kumar', '2026-05-01 13:11:28', '2026-05-01 13:11:28'),
(13, 2, 'phone_number', '416-578-0907', '2026-05-01 13:11:28', '2026-05-01 13:11:28'),
(14, 2, 'email_address', 'vikash@tastechnologies.com', '2026-05-01 13:11:28', '2026-05-01 13:11:28'),
(15, 2, 'address', '1155 North Service Rd W Suite 11', '2026-05-01 13:11:28', '2026-05-01 13:11:28'),
(16, 2, 'preferred_date', '2026-05-22', '2026-05-01 13:11:28', '2026-05-01 13:11:28'),
(17, 2, 'preferred_time', 'Afternoon', '2026-05-01 13:11:28', '2026-05-01 13:11:28'),
(18, 2, 'message', 'Just for testing purpose, please ignore it.', '2026-05-01 13:11:28', '2026-05-01 13:11:28'),
(19, 3, 'preferred_location', 'Burlington', '2026-05-02 00:07:17', '2026-05-02 00:07:17'),
(20, 3, 'services', 'Teeth Whitening', '2026-05-02 00:07:17', '2026-05-02 00:07:17'),
(21, 3, 'full_name', 'Vikash Kumar', '2026-05-02 00:07:17', '2026-05-02 00:07:17'),
(22, 3, 'phone_number', '416-578-0907', '2026-05-02 00:07:17', '2026-05-02 00:07:17'),
(23, 3, 'email_address', 'vikash@tastechnologies.com', '2026-05-02 00:07:17', '2026-05-02 00:07:17'),
(24, 3, 'address', '1155 North Service Rd W Suite 11', '2026-05-02 00:07:17', '2026-05-02 00:07:17'),
(25, 3, 'preferred_date', '2026-05-21', '2026-05-02 00:07:17', '2026-05-02 00:07:17'),
(26, 3, 'preferred_time', 'Afternoon', '2026-05-02 00:07:18', '2026-05-02 00:07:18'),
(27, 3, 'message', 'Just for testing purpose, please ignore it.', '2026-05-02 00:07:18', '2026-05-02 00:07:18'),
(28, 4, 'preferred_location', 'Burlington', '2026-05-02 01:06:36', '2026-05-02 01:06:36'),
(29, 4, 'services', 'Family Dentistry', '2026-05-02 01:06:36', '2026-05-02 01:06:36'),
(30, 4, 'full_name', 'Vikash Kumar', '2026-05-02 01:06:36', '2026-05-02 01:06:36'),
(31, 4, 'phone_number', '416-578-0907', '2026-05-02 01:06:36', '2026-05-02 01:06:36'),
(32, 4, 'email_address', 'vikash@tastechnologies.com', '2026-05-02 01:06:36', '2026-05-02 01:06:36'),
(33, 4, 'address', '1155 North Service Rd W Suite 11', '2026-05-02 01:06:36', '2026-05-02 01:06:36'),
(34, 4, 'preferred_date', '2026-05-28', '2026-05-02 01:06:36', '2026-05-02 01:06:36'),
(35, 4, 'preferred_time', 'Morning', '2026-05-02 01:06:36', '2026-05-02 01:06:36'),
(36, 4, 'message', 'Just for testing purpose, please ignore it.', '2026-05-02 01:06:36', '2026-05-02 01:06:36'),
(37, 5, 'patient_type', 'New Patient', '2026-05-02 02:34:39', '2026-05-02 02:34:39'),
(38, 5, 'preferred_location', 'Mississauga', '2026-05-02 02:34:39', '2026-05-02 02:34:39'),
(39, 5, 'full_name', 'Vikash Kumar', '2026-05-02 02:34:39', '2026-05-02 02:34:39'),
(40, 5, 'phone_number', '416-578-0907', '2026-05-02 02:34:39', '2026-05-02 02:34:39'),
(41, 5, 'email_address', 'vikash@tastechnologies.com', '2026-05-02 02:34:39', '2026-05-02 02:34:39'),
(42, 5, 'address', '1155 North Service Rd W Suite 11', '2026-05-02 02:34:39', '2026-05-02 02:34:39'),
(43, 5, 'preferred_date', '2026-05-27', '2026-05-02 02:34:39', '2026-05-02 02:34:39'),
(44, 5, 'preferred_time', 'Afternoon', '2026-05-02 02:34:39', '2026-05-02 02:34:39'),
(45, 5, 'message', 'Just for testing purpose, please ignore it.', '2026-05-02 02:34:39', '2026-05-02 02:34:39'),
(46, 6, 'patient_type', 'New Patient', '2026-05-02 02:37:46', '2026-05-02 02:37:46'),
(47, 6, 'preferred_location', 'Mississauga', '2026-05-02 02:37:46', '2026-05-02 02:37:46'),
(48, 6, 'full_name', 'Vikash Kumar', '2026-05-02 02:37:46', '2026-05-02 02:37:46'),
(49, 6, 'phone_number', '416-578-0907', '2026-05-02 02:37:46', '2026-05-02 02:37:46'),
(50, 6, 'email_address', 'vikash@tastechnologies.com', '2026-05-02 02:37:46', '2026-05-02 02:37:46'),
(51, 6, 'address', '1155 North Service Rd W Suite 11', '2026-05-02 02:37:46', '2026-05-02 02:37:46'),
(52, 6, 'preferred_date', '2026-05-27', '2026-05-02 02:37:46', '2026-05-02 02:37:46'),
(53, 6, 'preferred_time', 'undefined', '2026-05-02 02:37:46', '2026-05-02 02:37:46'),
(54, 6, 'message', 'Just for testing purpose, please ignore it.', '2026-05-02 02:37:46', '2026-05-02 02:37:46'),
(55, 7, 'patient_type', 'Returning Patient', '2026-05-02 02:38:53', '2026-05-02 02:38:53'),
(56, 7, 'preferred_location', 'Oakville', '2026-05-02 02:38:53', '2026-05-02 02:38:53'),
(57, 7, 'full_name', 'Vikash Kumar', '2026-05-02 02:38:53', '2026-05-02 02:38:53'),
(58, 7, 'phone_number', '416-578-0907', '2026-05-02 02:38:53', '2026-05-02 02:38:53'),
(59, 7, 'email_address', 'vikash@tastechnologies.com', '2026-05-02 02:38:53', '2026-05-02 02:38:53'),
(60, 7, 'address', '1155 North Service Rd W Suite 11', '2026-05-02 02:38:53', '2026-05-02 02:38:53'),
(61, 7, 'preferred_date', '2026-05-13', '2026-05-02 02:38:53', '2026-05-02 02:38:53'),
(62, 7, 'preferred_time', 'Evening', '2026-05-02 02:38:53', '2026-05-02 02:38:53'),
(63, 7, 'message', 'Just for testing purpose, please ignore it.', '2026-05-02 02:38:53', '2026-05-02 02:38:53'),
(64, 8, 'patient_type', 'New Patient', '2026-05-02 03:42:35', '2026-05-02 03:42:35'),
(65, 8, 'preferred_location', 'Burlington', '2026-05-02 03:42:35', '2026-05-02 03:42:35'),
(66, 8, 'full_name', 'Vikash Kumar', '2026-05-02 03:42:35', '2026-05-02 03:42:35'),
(67, 8, 'phone_number', '416-578-0907', '2026-05-02 03:42:35', '2026-05-02 03:42:35'),
(68, 8, 'email_address', 'vikash@tastechnologies.com', '2026-05-02 03:42:35', '2026-05-02 03:42:35'),
(69, 8, 'address', '1155 North Service Rd W Suite 11', '2026-05-02 03:42:35', '2026-05-02 03:42:35'),
(70, 8, 'preferred_date', '2026-05-20', '2026-05-02 03:42:35', '2026-05-02 03:42:35'),
(71, 8, 'preferred_time', 'Morning', '2026-05-02 03:42:35', '2026-05-02 03:42:35'),
(72, 8, 'message', 'Just for testing purpose, please ignore it.', '2026-05-02 03:42:35', '2026-05-02 03:42:35'),
(73, 9, 'patient_type', 'New Patient', '2026-05-02 08:49:42', '2026-05-02 08:49:42'),
(74, 9, 'preferred_location', 'Burlington', '2026-05-02 08:49:42', '2026-05-02 08:49:42'),
(75, 9, 'full_name', 'Vikash Kumar', '2026-05-02 08:49:42', '2026-05-02 08:49:42'),
(76, 9, 'phone_number', '416-578-0907', '2026-05-02 08:49:42', '2026-05-02 08:49:42'),
(77, 9, 'email_address', 'vikash@tastechnologies.com', '2026-05-02 08:49:42', '2026-05-02 08:49:42'),
(78, 9, 'address', '1155 North Service Rd W Suite 11', '2026-05-02 08:49:42', '2026-05-02 08:49:42'),
(79, 9, 'preferred_date', '2026-05-14', '2026-05-02 08:49:42', '2026-05-02 08:49:42'),
(80, 9, 'preferred_time', 'Afternoon', '2026-05-02 08:49:42', '2026-05-02 08:49:42'),
(81, 9, 'message', 'Just for testing purpose, please ignore it.', '2026-05-02 08:49:42', '2026-05-02 08:49:42'),
(82, 10, 'patient_type', 'Returning Patient', '2026-05-02 09:25:13', '2026-05-02 09:25:13'),
(83, 10, 'preferred_location', 'Oakville', '2026-05-02 09:25:13', '2026-05-02 09:25:13'),
(84, 10, 'full_name', 'Vikash Kumar', '2026-05-02 09:25:13', '2026-05-02 09:25:13'),
(85, 10, 'phone_number', '416-578-0907', '2026-05-02 09:25:13', '2026-05-02 09:25:13'),
(86, 10, 'email_address', 'vikash@tastechnologies.com', '2026-05-02 09:25:13', '2026-05-02 09:25:13'),
(87, 10, 'address', '1155 North Service Rd W Suite 11', '2026-05-02 09:25:13', '2026-05-02 09:25:13'),
(88, 10, 'preferred_date', '2026-05-19', '2026-05-02 09:25:13', '2026-05-02 09:25:13'),
(89, 10, 'preferred_time', 'Evening', '2026-05-02 09:25:13', '2026-05-02 09:25:13'),
(90, 10, 'message', 'Just for testing purpose, please ignore it.', '2026-05-02 09:25:13', '2026-05-02 09:25:13'),
(91, 11, 'patient_type', 'New Patient', '2026-05-02 09:33:00', '2026-05-02 09:33:00'),
(92, 11, 'preferred_location', 'Mississauga', '2026-05-02 09:33:01', '2026-05-02 09:33:01'),
(93, 11, 'full_name', 'Vikash Kumar', '2026-05-02 09:33:01', '2026-05-02 09:33:01'),
(94, 11, 'phone_number', '416-578-0907', '2026-05-02 09:33:02', '2026-05-02 09:33:02'),
(95, 11, 'email_address', 'vikash@tastechnologies.com', '2026-05-02 09:33:03', '2026-05-02 09:33:03'),
(96, 11, 'address', '1155 North Service Rd W Suite 11', '2026-05-02 09:33:03', '2026-05-02 09:33:03'),
(97, 11, 'preferred_date', '2026-05-20', '2026-05-02 09:33:03', '2026-05-02 09:33:03'),
(98, 11, 'preferred_time', 'Morning', '2026-05-02 09:33:03', '2026-05-02 09:33:03'),
(99, 11, 'message', 'Just for testing purpose, please ignore it.', '2026-05-02 09:33:03', '2026-05-02 09:33:03'),
(100, 12, 'select_location', 'Mississauga', '2026-05-02 10:54:02', '2026-05-02 10:54:02'),
(101, 12, 'full_name', 'Vikash Kumar', '2026-05-02 10:54:02', '2026-05-02 10:54:02'),
(102, 12, 'phone_number', '416-578-0907', '2026-05-02 10:54:02', '2026-05-02 10:54:02'),
(103, 12, 'email_address', 'vikash@tastechnologies.com', '2026-05-02 10:54:02', '2026-05-02 10:54:02'),
(104, 12, 'service_type', 'CDPC Patient', '2026-05-02 10:54:02', '2026-05-02 10:54:02'),
(105, 12, 'comments', 'Just for testing purpose, please ignore it.', '2026-05-02 10:54:02', '2026-05-02 10:54:02'),
(106, 13, 'select_location', 'Mississauga', '2026-05-02 11:07:17', '2026-05-02 11:07:17'),
(107, 13, 'full_name', 'Vikash Kumar', '2026-05-02 11:07:17', '2026-05-02 11:07:17'),
(108, 13, 'phone_number', '416-578-0907', '2026-05-02 11:07:17', '2026-05-02 11:07:17'),
(109, 13, 'email_address', 'vikash@tastechnologies.com', '2026-05-02 11:07:17', '2026-05-02 11:07:17'),
(110, 13, 'service_type', 'Others', '2026-05-02 11:07:17', '2026-05-02 11:07:17'),
(111, 13, 'comments', 'Just for testing purpose, please ignore it.', '2026-05-02 11:07:17', '2026-05-02 11:07:17'),
(967, 24, 'title', 'Mr.', '2026-05-15 04:11:25', '2026-05-15 04:11:25'),
(968, 24, 'full_name', 'Vikash Kumar', '2026-05-15 04:11:25', '2026-05-15 04:11:25'),
(969, 24, 'sex', 'Male', '2026-05-15 04:11:25', '2026-05-15 04:11:25'),
(970, 24, 'marital_status', 'Married', '2026-05-15 04:11:25', '2026-05-15 04:11:25'),
(971, 24, 'date_of_birth', '2026-05-02', '2026-05-15 04:11:25', '2026-05-15 04:11:25'),
(972, 24, 'street_address', '1155 North Service Rd W Suite 11', '2026-05-15 04:11:25', '2026-05-15 04:11:25'),
(973, 24, 'city', 'Oakville ON', '2026-05-15 04:11:25', '2026-05-15 04:11:25'),
(974, 24, 'province', 'Oakville', '2026-05-15 04:11:25', '2026-05-15 04:11:25'),
(975, 24, 'postal_code', 'L6M 3E3', '2026-05-15 04:11:25', '2026-05-15 04:11:25'),
(976, 24, 'email_address', 'vikash@tastechnologies.com', '2026-05-15 04:11:25', '2026-05-15 04:11:25'),
(977, 24, 'home_phone', NULL, '2026-05-15 04:11:25', '2026-05-15 04:11:25'),
(978, 24, 'cell_phone', '416-578-0907', '2026-05-15 04:11:25', '2026-05-15 04:11:25'),
(979, 24, 'cccupation', NULL, '2026-05-15 04:11:25', '2026-05-15 04:11:25'),
(980, 24, 'employed_by', NULL, '2026-05-15 04:11:25', '2026-05-15 04:11:25'),
(981, 24, 'dental_insurance', NULL, '2026-05-15 04:11:25', '2026-05-15 04:11:25'),
(982, 24, 'insurance_company', NULL, '2026-05-15 04:11:25', '2026-05-15 04:11:25'),
(983, 24, 'policy_no', NULL, '2026-05-15 04:11:25', '2026-05-15 04:11:25'),
(984, 24, 'certificate_no', NULL, '2026-05-15 04:11:25', '2026-05-15 04:11:25'),
(985, 24, 'family_physician', NULL, '2026-05-15 04:11:25', '2026-05-15 04:11:25'),
(986, 24, 'physician_phone', NULL, '2026-05-15 04:11:25', '2026-05-15 04:11:25'),
(987, 24, 'previous_dentist', NULL, '2026-05-15 04:11:25', '2026-05-15 04:11:25'),
(988, 24, 'previous_dentist_phone', NULL, '2026-05-15 04:11:25', '2026-05-15 04:11:25'),
(989, 24, 'referral_credit', NULL, '2026-05-15 04:11:25', '2026-05-15 04:11:25'),
(990, 24, 'en_contact_name', NULL, '2026-05-15 04:11:25', '2026-05-15 04:11:25'),
(991, 24, 'en_relationship', NULL, '2026-05-15 04:11:25', '2026-05-15 04:11:25'),
(992, 24, 'en_address', NULL, '2026-05-15 04:11:25', '2026-05-15 04:11:25'),
(993, 24, 'en_phone_number', NULL, '2026-05-15 04:11:25', '2026-05-15 04:11:25'),
(994, 24, 'dlcp_examination', NULL, '2026-05-15 04:11:25', '2026-05-15 04:11:25'),
(995, 24, 'cup_care', NULL, '2026-05-15 04:11:25', '2026-05-15 04:11:25'),
(996, 24, 'cup_care_specify', NULL, '2026-05-15 04:11:25', '2026-05-15 04:11:25'),
(997, 24, 'frequent_headaches', NULL, '2026-05-15 04:11:25', '2026-05-15 04:11:25'),
(998, 24, 'smoke', NULL, '2026-05-15 04:11:25', '2026-05-15 04:11:25'),
(999, 24, 'drink_alcohol', NULL, '2026-05-15 04:11:25', '2026-05-15 04:11:25'),
(1000, 24, 'drink_alcohol_specify', NULL, '2026-05-15 04:11:25', '2026-05-15 04:11:25'),
(1001, 24, 'recreational_drugs', NULL, '2026-05-15 04:11:25', '2026-05-15 04:11:25'),
(1002, 24, 'herbal_substances', NULL, '2026-05-15 04:11:25', '2026-05-15 04:11:25'),
(1003, 24, 'herbal_substances_specify', NULL, '2026-05-15 04:11:25', '2026-05-15 04:11:25'),
(1004, 24, 'any_medications', NULL, '2026-05-15 04:11:25', '2026-05-15 04:11:25'),
(1005, 24, 'any_medications_specify', NULL, '2026-05-15 04:11:25', '2026-05-15 04:11:25'),
(1006, 24, 'prolonged_medication', NULL, '2026-05-15 04:11:25', '2026-05-15 04:11:25'),
(1007, 24, 'prolonged_medication_specify', NULL, '2026-05-15 04:11:25', '2026-05-15 04:11:25'),
(1008, 24, 'cortisone', NULL, '2026-05-15 04:11:25', '2026-05-15 04:11:25'),
(1009, 24, 'any_surgery', NULL, '2026-05-15 04:11:25', '2026-05-15 04:11:25'),
(1010, 24, 'any_surgery_specify', NULL, '2026-05-15 04:11:25', '2026-05-15 04:11:25'),
(1011, 24, 'ankles_swollen', NULL, '2026-05-15 04:11:25', '2026-05-15 04:11:25'),
(1012, 24, 'gained_lost_weight', NULL, '2026-05-15 04:11:25', '2026-05-15 04:11:25'),
(1013, 24, 'pregnant', NULL, '2026-05-15 04:11:25', '2026-05-15 04:11:25'),
(1014, 24, 'pregnant_weeks', NULL, '2026-05-15 04:11:25', '2026-05-15 04:11:25'),
(1015, 24, 'adverse_reaction', NULL, '2026-05-15 04:11:25', '2026-05-15 04:11:25'),
(1016, 24, 'allergic_adverse_reaction', NULL, '2026-05-15 04:11:25', '2026-05-15 04:11:25'),
(1017, 24, 'adverse_reactions', NULL, '2026-05-15 04:11:25', '2026-05-15 04:11:25'),
(1018, 24, 'adverse_reactions_specify', NULL, '2026-05-15 04:11:25', '2026-05-15 04:11:25'),
(1019, 24, 'treated', NULL, '2026-05-15 04:11:25', '2026-05-15 04:11:25'),
(1020, 24, 'heavy_bleeding', NULL, '2026-05-15 04:11:25', '2026-05-15 04:11:25'),
(1021, 24, 'anything_else_know', NULL, '2026-05-15 04:11:25', '2026-05-15 04:11:25'),
(1022, 24, 'anything_else_know_specify', NULL, '2026-05-15 04:11:25', '2026-05-15 04:11:25'),
(1023, 24, 'other_disease', NULL, '2026-05-15 04:11:25', '2026-05-15 04:11:25'),
(1024, 24, 'anything_about_health', NULL, '2026-05-15 04:11:25', '2026-05-15 04:11:25'),
(1025, 24, 'anything_about_health_specify', NULL, '2026-05-15 04:11:25', '2026-05-15 04:11:25'),
(1026, 24, 'speak_doctor_privately', NULL, '2026-05-15 04:11:25', '2026-05-15 04:11:25'),
(1027, 24, 'date_last_complete_exam', NULL, '2026-05-15 04:11:25', '2026-05-15 04:11:25'),
(1028, 24, 'date_last_cleaning', NULL, '2026-05-15 04:11:25', '2026-05-15 04:11:25'),
(1029, 24, 'date_last_x_rays', NULL, '2026-05-15 04:11:25', '2026-05-15 04:11:25'),
(1030, 24, 'last_dentist_regularly', NULL, '2026-05-15 04:11:25', '2026-05-15 04:11:25'),
(1031, 24, 'last_dentist', NULL, '2026-05-15 04:11:25', '2026-05-15 04:11:25'),
(1032, 24, 'last_dentist_description', NULL, '2026-05-15 04:11:25', '2026-05-15 04:11:25'),
(1033, 24, 'antibiotics', NULL, '2026-05-15 04:11:25', '2026-05-15 04:11:25'),
(1034, 24, 'heavy_bleeding_extractions', NULL, '2026-05-15 04:11:25', '2026-05-15 04:11:25'),
(1035, 24, 'gum_treatment', NULL, '2026-05-15 04:11:25', '2026-05-15 04:11:25'),
(1036, 24, 'orthodontic_treatment', NULL, '2026-05-15 04:11:25', '2026-05-15 04:11:25'),
(1037, 24, 'unpleasant_dental_experience', NULL, '2026-05-15 04:11:25', '2026-05-15 04:11:25'),
(1038, 24, 'age', '22', '2026-05-15 04:11:25', '2026-05-15 04:11:25'),
(1039, 24, 'pleasant_dental_experience', NULL, '2026-05-15 04:11:25', '2026-05-15 04:11:25'),
(1040, 24, 'anything_else_should_know', NULL, '2026-05-15 04:11:25', '2026-05-15 04:11:25'),
(1041, 24, 'brings_office_today', NULL, '2026-05-15 04:11:25', '2026-05-15 04:11:25'),
(1042, 24, 'any_discomfort', NULL, '2026-05-15 04:11:25', '2026-05-15 04:11:25'),
(1043, 24, 'any_discomfort_specify', NULL, '2026-05-15 04:11:25', '2026-05-15 04:11:25'),
(1044, 24, 'have_experienced', NULL, '2026-05-15 04:11:25', '2026-05-15 04:11:25'),
(1045, 24, 'food_teeth', NULL, '2026-05-15 04:11:25', '2026-05-15 04:11:25'),
(1046, 24, 'sore_spots', NULL, '2026-05-15 04:11:25', '2026-05-15 04:11:25'),
(1047, 24, 'teeth_replaced', NULL, '2026-05-15 04:11:25', '2026-05-15 04:11:25'),
(1048, 24, 'permanent_tooth_replacement', NULL, '2026-05-15 04:11:25', '2026-05-15 04:11:25'),
(1049, 24, 'local_anesthesia', NULL, '2026-05-15 04:11:25', '2026-05-15 04:11:25'),
(1050, 24, 'general_anesthesia', NULL, '2026-05-15 04:11:25', '2026-05-15 04:11:25'),
(1051, 24, 'satisfied_appearance_teeth', NULL, '2026-05-15 04:11:25', '2026-05-15 04:11:25'),
(1052, 24, 'keep_natural_teeth', NULL, '2026-05-15 04:11:25', '2026-05-15 04:11:25'),
(1053, 24, 'tense_dental_visits', NULL, '2026-05-15 04:11:25', '2026-05-15 04:11:25'),
(1054, 24, 'calm_nerves', NULL, '2026-05-15 04:11:25', '2026-05-15 04:11:25'),
(1055, 24, 'describe', 'Just for testing purpose, please ignore it.', '2026-05-15 04:11:25', '2026-05-15 04:11:25'),
(1056, 24, 'signature', 'signature_24_1778832685.png', '2026-05-15 04:11:25', '2026-05-15 04:11:25'),
(1057, 24, 'print_name', 'Vikash Kumar', '2026-05-15 04:11:25', '2026-05-15 04:11:25'),
(1058, 24, 'location', 'Mississauga', '2026-05-15 04:11:25', '2026-05-15 04:11:25'),
(1059, 24, 'consent_privacy_patient', 'Yes', '2026-05-15 04:11:25', '2026-05-15 04:11:25'),
(1060, 24, 'privacy_patient_name', 'Vikash Kumar', '2026-05-15 04:11:25', '2026-05-15 04:11:25'),
(1061, 24, 'consent_newsletter', NULL, '2026-05-15 04:11:25', '2026-05-15 04:11:25'),
(1062, 25, 'title', 'Mr.', '2026-05-15 04:28:16', '2026-05-15 04:28:16'),
(1063, 25, 'full_name', 'Vikash Kumar', '2026-05-15 04:28:16', '2026-05-15 04:28:16'),
(1064, 25, 'sex', 'Male', '2026-05-15 04:28:16', '2026-05-15 04:28:16'),
(1065, 25, 'marital_status', 'Married', '2026-05-15 04:28:16', '2026-05-15 04:28:16'),
(1066, 25, 'date_of_birth', '2026-05-02', '2026-05-15 04:28:16', '2026-05-15 04:28:16'),
(1067, 25, 'street_address', '1155 North Service Rd W Suite 11', '2026-05-15 04:28:16', '2026-05-15 04:28:16'),
(1068, 25, 'city', 'Oakville ON', '2026-05-15 04:28:16', '2026-05-15 04:28:16'),
(1069, 25, 'province', 'Oakville', '2026-05-15 04:28:16', '2026-05-15 04:28:16'),
(1070, 25, 'postal_code', 'L6M 3E3', '2026-05-15 04:28:16', '2026-05-15 04:28:16'),
(1071, 25, 'email_address', 'vikash@tastechnologies.com', '2026-05-15 04:28:16', '2026-05-15 04:28:16'),
(1072, 25, 'home_phone', NULL, '2026-05-15 04:28:16', '2026-05-15 04:28:16'),
(1073, 25, 'cell_phone', '416-578-0907', '2026-05-15 04:28:16', '2026-05-15 04:28:16'),
(1074, 25, 'cccupation', NULL, '2026-05-15 04:28:16', '2026-05-15 04:28:16'),
(1075, 25, 'employed_by', NULL, '2026-05-15 04:28:16', '2026-05-15 04:28:16'),
(1076, 25, 'dental_insurance', NULL, '2026-05-15 04:28:16', '2026-05-15 04:28:16'),
(1077, 25, 'insurance_company', NULL, '2026-05-15 04:28:16', '2026-05-15 04:28:16'),
(1078, 25, 'policy_no', NULL, '2026-05-15 04:28:16', '2026-05-15 04:28:16'),
(1079, 25, 'certificate_no', NULL, '2026-05-15 04:28:16', '2026-05-15 04:28:16'),
(1080, 25, 'family_physician', NULL, '2026-05-15 04:28:16', '2026-05-15 04:28:16'),
(1081, 25, 'physician_phone', NULL, '2026-05-15 04:28:16', '2026-05-15 04:28:16'),
(1082, 25, 'previous_dentist', NULL, '2026-05-15 04:28:16', '2026-05-15 04:28:16'),
(1083, 25, 'previous_dentist_phone', NULL, '2026-05-15 04:28:16', '2026-05-15 04:28:16'),
(1084, 25, 'referral_credit', NULL, '2026-05-15 04:28:16', '2026-05-15 04:28:16'),
(1085, 25, 'en_contact_name', NULL, '2026-05-15 04:28:16', '2026-05-15 04:28:16'),
(1086, 25, 'en_relationship', NULL, '2026-05-15 04:28:16', '2026-05-15 04:28:16'),
(1087, 25, 'en_address', NULL, '2026-05-15 04:28:16', '2026-05-15 04:28:16'),
(1088, 25, 'en_phone_number', NULL, '2026-05-15 04:28:16', '2026-05-15 04:28:16'),
(1089, 25, 'dlcp_examination', NULL, '2026-05-15 04:28:16', '2026-05-15 04:28:16'),
(1090, 25, 'cup_care', NULL, '2026-05-15 04:28:16', '2026-05-15 04:28:16'),
(1091, 25, 'cup_care_specify', NULL, '2026-05-15 04:28:16', '2026-05-15 04:28:16'),
(1092, 25, 'frequent_headaches', NULL, '2026-05-15 04:28:16', '2026-05-15 04:28:16'),
(1093, 25, 'smoke', NULL, '2026-05-15 04:28:16', '2026-05-15 04:28:16'),
(1094, 25, 'drink_alcohol', NULL, '2026-05-15 04:28:16', '2026-05-15 04:28:16'),
(1095, 25, 'drink_alcohol_specify', NULL, '2026-05-15 04:28:16', '2026-05-15 04:28:16'),
(1096, 25, 'recreational_drugs', NULL, '2026-05-15 04:28:16', '2026-05-15 04:28:16'),
(1097, 25, 'herbal_substances', NULL, '2026-05-15 04:28:16', '2026-05-15 04:28:16'),
(1098, 25, 'herbal_substances_specify', NULL, '2026-05-15 04:28:16', '2026-05-15 04:28:16'),
(1099, 25, 'any_medications', NULL, '2026-05-15 04:28:16', '2026-05-15 04:28:16'),
(1100, 25, 'any_medications_specify', NULL, '2026-05-15 04:28:16', '2026-05-15 04:28:16'),
(1101, 25, 'prolonged_medication', NULL, '2026-05-15 04:28:16', '2026-05-15 04:28:16'),
(1102, 25, 'prolonged_medication_specify', NULL, '2026-05-15 04:28:16', '2026-05-15 04:28:16'),
(1103, 25, 'cortisone', NULL, '2026-05-15 04:28:16', '2026-05-15 04:28:16'),
(1104, 25, 'any_surgery', NULL, '2026-05-15 04:28:16', '2026-05-15 04:28:16'),
(1105, 25, 'any_surgery_specify', NULL, '2026-05-15 04:28:16', '2026-05-15 04:28:16'),
(1106, 25, 'ankles_swollen', NULL, '2026-05-15 04:28:16', '2026-05-15 04:28:16'),
(1107, 25, 'gained_lost_weight', NULL, '2026-05-15 04:28:16', '2026-05-15 04:28:16'),
(1108, 25, 'pregnant', NULL, '2026-05-15 04:28:16', '2026-05-15 04:28:16'),
(1109, 25, 'pregnant_weeks', NULL, '2026-05-15 04:28:16', '2026-05-15 04:28:16'),
(1110, 25, 'adverse_reaction', NULL, '2026-05-15 04:28:16', '2026-05-15 04:28:16'),
(1111, 25, 'allergic_adverse_reaction', NULL, '2026-05-15 04:28:16', '2026-05-15 04:28:16'),
(1112, 25, 'adverse_reactions', NULL, '2026-05-15 04:28:16', '2026-05-15 04:28:16'),
(1113, 25, 'adverse_reactions_specify', NULL, '2026-05-15 04:28:16', '2026-05-15 04:28:16'),
(1114, 25, 'treated', NULL, '2026-05-15 04:28:16', '2026-05-15 04:28:16'),
(1115, 25, 'heavy_bleeding', NULL, '2026-05-15 04:28:16', '2026-05-15 04:28:16'),
(1116, 25, 'anything_else_know', NULL, '2026-05-15 04:28:16', '2026-05-15 04:28:16'),
(1117, 25, 'anything_else_know_specify', NULL, '2026-05-15 04:28:16', '2026-05-15 04:28:16'),
(1118, 25, 'other_disease', NULL, '2026-05-15 04:28:16', '2026-05-15 04:28:16'),
(1119, 25, 'anything_about_health', NULL, '2026-05-15 04:28:16', '2026-05-15 04:28:16'),
(1120, 25, 'anything_about_health_specify', NULL, '2026-05-15 04:28:16', '2026-05-15 04:28:16'),
(1121, 25, 'speak_doctor_privately', NULL, '2026-05-15 04:28:16', '2026-05-15 04:28:16'),
(1122, 25, 'date_last_complete_exam', NULL, '2026-05-15 04:28:16', '2026-05-15 04:28:16'),
(1123, 25, 'date_last_cleaning', NULL, '2026-05-15 04:28:16', '2026-05-15 04:28:16'),
(1124, 25, 'date_last_x_rays', NULL, '2026-05-15 04:28:16', '2026-05-15 04:28:16'),
(1125, 25, 'last_dentist_regularly', NULL, '2026-05-15 04:28:16', '2026-05-15 04:28:16'),
(1126, 25, 'last_dentist', NULL, '2026-05-15 04:28:16', '2026-05-15 04:28:16'),
(1127, 25, 'last_dentist_description', NULL, '2026-05-15 04:28:16', '2026-05-15 04:28:16'),
(1128, 25, 'antibiotics', NULL, '2026-05-15 04:28:16', '2026-05-15 04:28:16'),
(1129, 25, 'heavy_bleeding_extractions', NULL, '2026-05-15 04:28:16', '2026-05-15 04:28:16'),
(1130, 25, 'gum_treatment', NULL, '2026-05-15 04:28:16', '2026-05-15 04:28:16'),
(1131, 25, 'orthodontic_treatment', NULL, '2026-05-15 04:28:16', '2026-05-15 04:28:16'),
(1132, 25, 'unpleasant_dental_experience', NULL, '2026-05-15 04:28:16', '2026-05-15 04:28:16'),
(1133, 25, 'age', '22', '2026-05-15 04:28:16', '2026-05-15 04:28:16'),
(1134, 25, 'pleasant_dental_experience', NULL, '2026-05-15 04:28:16', '2026-05-15 04:28:16'),
(1135, 25, 'anything_else_should_know', NULL, '2026-05-15 04:28:16', '2026-05-15 04:28:16'),
(1136, 25, 'brings_office_today', NULL, '2026-05-15 04:28:16', '2026-05-15 04:28:16'),
(1137, 25, 'any_discomfort', NULL, '2026-05-15 04:28:16', '2026-05-15 04:28:16'),
(1138, 25, 'any_discomfort_specify', NULL, '2026-05-15 04:28:16', '2026-05-15 04:28:16'),
(1139, 25, 'have_experienced', NULL, '2026-05-15 04:28:16', '2026-05-15 04:28:16'),
(1140, 25, 'food_teeth', NULL, '2026-05-15 04:28:16', '2026-05-15 04:28:16'),
(1141, 25, 'sore_spots', NULL, '2026-05-15 04:28:16', '2026-05-15 04:28:16'),
(1142, 25, 'teeth_replaced', NULL, '2026-05-15 04:28:16', '2026-05-15 04:28:16'),
(1143, 25, 'permanent_tooth_replacement', NULL, '2026-05-15 04:28:16', '2026-05-15 04:28:16'),
(1144, 25, 'local_anesthesia', NULL, '2026-05-15 04:28:16', '2026-05-15 04:28:16'),
(1145, 25, 'general_anesthesia', NULL, '2026-05-15 04:28:16', '2026-05-15 04:28:16'),
(1146, 25, 'satisfied_appearance_teeth', NULL, '2026-05-15 04:28:16', '2026-05-15 04:28:16'),
(1147, 25, 'keep_natural_teeth', NULL, '2026-05-15 04:28:16', '2026-05-15 04:28:16'),
(1148, 25, 'tense_dental_visits', NULL, '2026-05-15 04:28:16', '2026-05-15 04:28:16'),
(1149, 25, 'calm_nerves', NULL, '2026-05-15 04:28:16', '2026-05-15 04:28:16'),
(1150, 25, 'describe', 'sdsds', '2026-05-15 04:28:16', '2026-05-15 04:28:16'),
(1151, 25, 'signature', 'signature_25_1778833695.png', '2026-05-15 04:28:16', '2026-05-15 04:28:16'),
(1152, 25, 'print_name', 'Vikash Kumar', '2026-05-15 04:28:16', '2026-05-15 04:28:16'),
(1153, 25, 'location', 'Oakville', '2026-05-15 04:28:16', '2026-05-15 04:28:16'),
(1154, 25, 'consent_privacy_patient', 'Yes', '2026-05-15 04:28:16', '2026-05-15 04:28:16'),
(1155, 25, 'privacy_patient_name', 'Vikash Kumar', '2026-05-15 04:28:16', '2026-05-15 04:28:16'),
(1156, 25, 'consent_newsletter', NULL, '2026-05-15 04:28:16', '2026-05-15 04:28:16'),
(1157, 26, 'title', 'Mr.', '2026-05-15 23:25:36', '2026-05-15 23:25:36'),
(1158, 26, 'full_name', 'Vikash Kumar', '2026-05-15 23:25:36', '2026-05-15 23:25:36'),
(1159, 26, 'sex', 'Male', '2026-05-15 23:25:36', '2026-05-15 23:25:36'),
(1160, 26, 'marital_status', 'Single', '2026-05-15 23:25:36', '2026-05-15 23:25:36'),
(1161, 26, 'date_of_birth', '2026-05-06', '2026-05-15 23:25:36', '2026-05-15 23:25:36'),
(1162, 26, 'street_address', '1155 North Service Rd W Suite 11', '2026-05-15 23:25:36', '2026-05-15 23:25:36'),
(1163, 26, 'city', 'Oakville ON', '2026-05-15 23:25:36', '2026-05-15 23:25:36'),
(1164, 26, 'province', 'Oakville', '2026-05-15 23:25:36', '2026-05-15 23:25:36'),
(1165, 26, 'postal_code', 'L6M 3E3', '2026-05-15 23:25:36', '2026-05-15 23:25:36'),
(1166, 26, 'email_address', 'vikash@tastechnologies.com', '2026-05-15 23:25:36', '2026-05-15 23:25:36'),
(1167, 26, 'home_phone', '416-578-0907', '2026-05-15 23:25:36', '2026-05-15 23:25:36'),
(1168, 26, 'cell_phone', '416-578-0907', '2026-05-15 23:25:36', '2026-05-15 23:25:36'),
(1169, 26, 'cccupation', 'NA', '2026-05-15 23:25:36', '2026-05-15 23:25:36'),
(1170, 26, 'employed_by', 'NA', '2026-05-15 23:25:36', '2026-05-15 23:25:36'),
(1171, 26, 'dental_insurance', 'Yes', '2026-05-15 23:25:36', '2026-05-15 23:25:36'),
(1172, 26, 'insurance_company', 'NA', '2026-05-15 23:25:36', '2026-05-15 23:25:36'),
(1173, 26, 'policy_no', 'NA', '2026-05-15 23:25:36', '2026-05-15 23:25:36'),
(1174, 26, 'certificate_no', 'NA', '2026-05-15 23:25:36', '2026-05-15 23:25:36'),
(1175, 26, 'family_physician', 'NA', '2026-05-15 23:25:36', '2026-05-15 23:25:36'),
(1176, 26, 'physician_phone', 'NA', '2026-05-15 23:25:36', '2026-05-15 23:25:36'),
(1177, 26, 'previous_dentist', 'NA', '2026-05-15 23:25:36', '2026-05-15 23:25:36'),
(1178, 26, 'previous_dentist_phone', 'NA', '2026-05-15 23:25:36', '2026-05-15 23:25:36'),
(1179, 26, 'referral_credit', 'NA', '2026-05-15 23:25:36', '2026-05-15 23:25:36'),
(1180, 26, 'en_contact_name', 'Vikash Kumar', '2026-05-15 23:25:36', '2026-05-15 23:25:36'),
(1181, 26, 'en_relationship', 'NA', '2026-05-15 23:25:36', '2026-05-15 23:25:36'),
(1182, 26, 'en_address', 'NA', '2026-05-15 23:25:36', '2026-05-15 23:25:36'),
(1183, 26, 'en_phone_number', 'NA', '2026-05-15 23:25:36', '2026-05-15 23:25:36'),
(1184, 26, 'dlcp_examination', '2026-05-07', '2026-05-15 23:25:36', '2026-05-15 23:25:36'),
(1185, 26, 'cup_care', 'Yes', '2026-05-15 23:25:36', '2026-05-15 23:25:36'),
(1186, 26, 'cup_care_specify', 'NA', '2026-05-15 23:25:36', '2026-05-15 23:25:36'),
(1187, 26, 'frequent_headaches', 'No', '2026-05-15 23:25:36', '2026-05-15 23:25:36'),
(1188, 26, 'smoke', 'No', '2026-05-15 23:25:36', '2026-05-15 23:25:36'),
(1189, 26, 'drink_alcohol', 'Yes', '2026-05-15 23:25:36', '2026-05-15 23:25:36'),
(1190, 26, 'drink_alcohol_specify', 'NA', '2026-05-15 23:25:36', '2026-05-15 23:25:36'),
(1191, 26, 'recreational_drugs', 'No', '2026-05-15 23:25:36', '2026-05-15 23:25:36'),
(1192, 26, 'herbal_substances', 'Yes', '2026-05-15 23:25:36', '2026-05-15 23:25:36'),
(1193, 26, 'herbal_substances_specify', 'NA', '2026-05-15 23:25:36', '2026-05-15 23:25:36'),
(1194, 26, 'any_medications', 'Yes', '2026-05-15 23:25:36', '2026-05-15 23:25:36'),
(1195, 26, 'any_medications_specify', 'NA', '2026-05-15 23:25:36', '2026-05-15 23:25:36'),
(1196, 26, 'prolonged_medication', 'Yes', '2026-05-15 23:25:36', '2026-05-15 23:25:36'),
(1197, 26, 'prolonged_medication_specify', 'NA', '2026-05-15 23:25:36', '2026-05-15 23:25:36'),
(1198, 26, 'cortisone', 'No', '2026-05-15 23:25:36', '2026-05-15 23:25:36'),
(1199, 26, 'any_surgery', 'Yes', '2026-05-15 23:25:36', '2026-05-15 23:25:36'),
(1200, 26, 'any_surgery_specify', 'NA', '2026-05-15 23:25:36', '2026-05-15 23:25:36'),
(1201, 26, 'ankles_swollen', 'No', '2026-05-15 23:25:36', '2026-05-15 23:25:36'),
(1202, 26, 'gained_lost_weight', 'No', '2026-05-15 23:25:36', '2026-05-15 23:25:36'),
(1203, 26, 'pregnant', 'Yes', '2026-05-15 23:25:36', '2026-05-15 23:25:36'),
(1204, 26, 'pregnant_weeks', 'NA', '2026-05-15 23:25:36', '2026-05-15 23:25:36'),
(1205, 26, 'adverse_reaction', 'Latex, Metals, Sulfa Drugs', '2026-05-15 23:25:36', '2026-05-15 23:25:36'),
(1206, 26, 'allergic_adverse_reaction', 'Aspirin, Local Anesthetic (Freezing), Nitrous Oxide, Codeine', '2026-05-15 23:25:36', '2026-05-15 23:25:36'),
(1207, 26, 'adverse_reactions', 'Yes', '2026-05-15 23:25:36', '2026-05-15 23:25:36'),
(1208, 26, 'adverse_reactions_specify', 'NA', '2026-05-15 23:25:36', '2026-05-15 23:25:36'),
(1209, 26, 'treated', 'Heart Murmur, Arthritis, Hepatitis B, Hypertension / Low BP, Anemia, Liver Disease, Cancer, Rheumatic Fever, Diabetes Type I / Type II, Tuberculosis, Epilepsy, Venereal Disease', '2026-05-15 23:25:36', '2026-05-15 23:25:36'),
(1210, 26, 'heavy_bleeding', 'No', '2026-05-15 23:25:36', '2026-05-15 23:25:36'),
(1211, 26, 'anything_else_know', 'Yes', '2026-05-15 23:25:36', '2026-05-15 23:25:36'),
(1212, 26, 'anything_else_know_specify', 'NA', '2026-05-15 23:25:36', '2026-05-15 23:25:36'),
(1213, 26, 'other_disease', 'No', '2026-05-15 23:25:36', '2026-05-15 23:25:36'),
(1214, 26, 'anything_about_health', 'Yes', '2026-05-15 23:25:36', '2026-05-15 23:25:36'),
(1215, 26, 'anything_about_health_specify', 'NA', '2026-05-15 23:25:36', '2026-05-15 23:25:36'),
(1216, 26, 'speak_doctor_privately', 'No', '2026-05-15 23:25:36', '2026-05-15 23:25:36'),
(1217, 26, 'date_last_complete_exam', '2026-05-01', '2026-05-15 23:25:36', '2026-05-15 23:25:36'),
(1218, 26, 'date_last_cleaning', '2026-05-02', '2026-05-15 23:25:36', '2026-05-15 23:25:36'),
(1219, 26, 'date_last_x_rays', '2026-05-08', '2026-05-15 23:25:36', '2026-05-15 23:25:36'),
(1220, 26, 'last_dentist_regularly', 'Yes', '2026-05-15 23:25:36', '2026-05-15 23:25:36'),
(1221, 26, 'last_dentist', '3 Months', '2026-05-15 23:25:36', '2026-05-15 23:25:36'),
(1222, 26, 'last_dentist_description', 'NA', '2026-05-15 23:25:36', '2026-05-15 23:25:36'),
(1223, 26, 'antibiotics', 'Yes', '2026-05-15 23:25:36', '2026-05-15 23:25:36'),
(1224, 26, 'heavy_bleeding_extractions', 'Yes', '2026-05-15 23:25:36', '2026-05-15 23:25:36'),
(1225, 26, 'gum_treatment', 'Yes', '2026-05-15 23:25:36', '2026-05-15 23:25:36'),
(1226, 26, 'orthodontic_treatment', 'Yes', '2026-05-15 23:25:36', '2026-05-15 23:25:36'),
(1227, 26, 'unpleasant_dental_experience', 'Yes', '2026-05-15 23:25:36', '2026-05-15 23:25:36'),
(1228, 26, 'age', '22', '2026-05-15 23:25:36', '2026-05-15 23:25:36'),
(1229, 26, 'pleasant_dental_experience', 'NA', '2026-05-15 23:25:36', '2026-05-15 23:25:36'),
(1230, 26, 'anything_else_should_know', 'NA', '2026-05-15 23:25:36', '2026-05-15 23:25:36'),
(1231, 26, 'brings_office_today', 'NA', '2026-05-15 23:25:36', '2026-05-15 23:25:36'),
(1232, 26, 'any_discomfort', 'Yes', '2026-05-15 23:25:36', '2026-05-15 23:25:36'),
(1233, 26, 'any_discomfort_specify', 'NA', '2026-05-15 23:25:36', '2026-05-15 23:25:36'),
(1234, 26, 'have_experienced', 'Tooth sensitivity, Bad breath, Sore gums, Missing teeth, Loose Teeth, Spaced or Crooked teeth, Unexplained nosebleed, Difficulty opening or closing, Clench or Grind, Popping or clicking in the jaw joints, Emphysema, Epilepsy, Venereal Disease', '2026-05-15 23:25:36', '2026-05-15 23:25:36'),
(1235, 26, 'food_teeth', 'Yes', '2026-05-15 23:25:36', '2026-05-15 23:25:36'),
(1236, 26, 'sore_spots', 'Yes', '2026-05-15 23:25:36', '2026-05-15 23:25:36'),
(1237, 26, 'teeth_replaced', 'Yes', '2026-05-15 23:25:36', '2026-05-15 23:25:36'),
(1238, 26, 'permanent_tooth_replacement', 'Yes', '2026-05-15 23:25:36', '2026-05-15 23:25:36'),
(1239, 26, 'local_anesthesia', 'Yes', '2026-05-15 23:25:36', '2026-05-15 23:25:36'),
(1240, 26, 'general_anesthesia', 'Yes', '2026-05-15 23:25:36', '2026-05-15 23:25:36'),
(1241, 26, 'satisfied_appearance_teeth', 'Yes', '2026-05-15 23:25:36', '2026-05-15 23:25:36'),
(1242, 26, 'keep_natural_teeth', 'Yes', '2026-05-15 23:25:36', '2026-05-15 23:25:36'),
(1243, 26, 'tense_dental_visits', 'No', '2026-05-15 23:25:36', '2026-05-15 23:25:36'),
(1244, 26, 'calm_nerves', 'No', '2026-05-15 23:25:36', '2026-05-15 23:25:36'),
(1245, 26, 'describe', 'Just for testing purpose, please ignore it.', '2026-05-15 23:25:36', '2026-05-15 23:25:36'),
(1246, 26, 'signature', 'signature_26_1778901936.png', '2026-05-15 23:25:36', '2026-05-15 23:25:36'),
(1247, 26, 'print_name', 'Vikash Kumar', '2026-05-15 23:25:36', '2026-05-15 23:25:36'),
(1248, 26, 'location', 'Burlington', '2026-05-15 23:25:36', '2026-05-15 23:25:36'),
(1249, 26, 'consent_privacy_patient', 'Yes', '2026-05-15 23:25:36', '2026-05-15 23:25:36'),
(1250, 26, 'privacy_patient_name', 'Vikash Kumar', '2026-05-15 23:25:36', '2026-05-15 23:25:36'),
(1251, 26, 'consent_newsletter', NULL, '2026-05-15 23:25:36', '2026-05-15 23:25:36'),
(1252, 27, 'title', 'Mr.', '2026-05-16 02:11:14', '2026-05-16 02:11:14'),
(1253, 27, 'full_name', 'Vikash Kumar', '2026-05-16 02:11:14', '2026-05-16 02:11:14'),
(1254, 27, 'sex', 'Male', '2026-05-16 02:11:14', '2026-05-16 02:11:14'),
(1255, 27, 'marital_status', 'Single', '2026-05-16 02:11:14', '2026-05-16 02:11:14'),
(1256, 27, 'date_of_birth', '2026-05-01', '2026-05-16 02:11:14', '2026-05-16 02:11:14'),
(1257, 27, 'street_address', '1155 North Service Rd W Suite 11', '2026-05-16 02:11:14', '2026-05-16 02:11:14'),
(1258, 27, 'city', 'Oakville ON', '2026-05-16 02:11:14', '2026-05-16 02:11:14'),
(1259, 27, 'province', 'Oakville', '2026-05-16 02:11:14', '2026-05-16 02:11:14'),
(1260, 27, 'postal_code', 'L6M 3E3', '2026-05-16 02:11:14', '2026-05-16 02:11:14'),
(1261, 27, 'email_address', 'vikash@tastechnologies.com', '2026-05-16 02:11:14', '2026-05-16 02:11:14'),
(1262, 27, 'home_phone', '416-578-0907', '2026-05-16 02:11:14', '2026-05-16 02:11:14'),
(1263, 27, 'cell_phone', '416-578-0907', '2026-05-16 02:11:14', '2026-05-16 02:11:14'),
(1264, 27, 'cccupation', 'NA', '2026-05-16 02:11:14', '2026-05-16 02:11:14'),
(1265, 27, 'employed_by', 'NA', '2026-05-16 02:11:14', '2026-05-16 02:11:14'),
(1266, 27, 'dental_insurance', 'Yes', '2026-05-16 02:11:14', '2026-05-16 02:11:14'),
(1267, 27, 'insurance_company', 'NA', '2026-05-16 02:11:14', '2026-05-16 02:11:14'),
(1268, 27, 'policy_no', 'NA', '2026-05-16 02:11:14', '2026-05-16 02:11:14'),
(1269, 27, 'certificate_no', 'NA', '2026-05-16 02:11:14', '2026-05-16 02:11:14'),
(1270, 27, 'family_physician', 'NA', '2026-05-16 02:11:14', '2026-05-16 02:11:14'),
(1271, 27, 'physician_phone', 'NA', '2026-05-16 02:11:14', '2026-05-16 02:11:14'),
(1272, 27, 'previous_dentist', 'NA', '2026-05-16 02:11:14', '2026-05-16 02:11:14'),
(1273, 27, 'previous_dentist_phone', 'NA', '2026-05-16 02:11:14', '2026-05-16 02:11:14'),
(1274, 27, 'referral_credit', 'NA', '2026-05-16 02:11:14', '2026-05-16 02:11:14'),
(1275, 27, 'en_contact_name', 'Vikash Kumar', '2026-05-16 02:11:14', '2026-05-16 02:11:14'),
(1276, 27, 'en_relationship', 'NA', '2026-05-16 02:11:14', '2026-05-16 02:11:14'),
(1277, 27, 'en_address', 'NA', '2026-05-16 02:11:14', '2026-05-16 02:11:14'),
(1278, 27, 'en_phone_number', 'NA', '2026-05-16 02:11:14', '2026-05-16 02:11:14'),
(1279, 27, 'dlcp_examination', '2026-05-02', '2026-05-16 02:11:14', '2026-05-16 02:11:14'),
(1280, 27, 'cup_care', 'Yes', '2026-05-16 02:11:14', '2026-05-16 02:11:14'),
(1281, 27, 'cup_care_specify', 'NA', '2026-05-16 02:11:14', '2026-05-16 02:11:14'),
(1282, 27, 'frequent_headaches', 'No', '2026-05-16 02:11:14', '2026-05-16 02:11:14'),
(1283, 27, 'smoke', 'No', '2026-05-16 02:11:14', '2026-05-16 02:11:14'),
(1284, 27, 'drink_alcohol', 'Yes', '2026-05-16 02:11:14', '2026-05-16 02:11:14'),
(1285, 27, 'drink_alcohol_specify', 'NA', '2026-05-16 02:11:14', '2026-05-16 02:11:14'),
(1286, 27, 'recreational_drugs', 'No', '2026-05-16 02:11:14', '2026-05-16 02:11:14'),
(1287, 27, 'herbal_substances', 'Yes', '2026-05-16 02:11:14', '2026-05-16 02:11:14'),
(1288, 27, 'herbal_substances_specify', 'NA', '2026-05-16 02:11:14', '2026-05-16 02:11:14'),
(1289, 27, 'any_medications', 'Yes', '2026-05-16 02:11:14', '2026-05-16 02:11:14'),
(1290, 27, 'any_medications_specify', 'NA', '2026-05-16 02:11:14', '2026-05-16 02:11:14'),
(1291, 27, 'prolonged_medication', 'Yes', '2026-05-16 02:11:14', '2026-05-16 02:11:14'),
(1292, 27, 'prolonged_medication_specify', 'NA', '2026-05-16 02:11:14', '2026-05-16 02:11:14'),
(1293, 27, 'cortisone', 'No', '2026-05-16 02:11:14', '2026-05-16 02:11:14'),
(1294, 27, 'any_surgery', 'Yes', '2026-05-16 02:11:14', '2026-05-16 02:11:14'),
(1295, 27, 'any_surgery_specify', 'NA', '2026-05-16 02:11:14', '2026-05-16 02:11:14'),
(1296, 27, 'ankles_swollen', 'No', '2026-05-16 02:11:14', '2026-05-16 02:11:14'),
(1297, 27, 'gained_lost_weight', 'No', '2026-05-16 02:11:14', '2026-05-16 02:11:14'),
(1298, 27, 'pregnant', 'Yes', '2026-05-16 02:11:14', '2026-05-16 02:11:14'),
(1299, 27, 'pregnant_weeks', 'NA', '2026-05-16 02:11:14', '2026-05-16 02:11:14'),
(1300, 27, 'adverse_reaction', 'Latex, Penicillin, Metals, Sulfa Drugs', '2026-05-16 02:11:14', '2026-05-16 02:11:14'),
(1301, 27, 'allergic_adverse_reaction', 'Aspirin, Local Anesthetic (Freezing), Barbiturates (Sleeping pills), Nitrous Oxide, Codeine', '2026-05-16 02:11:14', '2026-05-16 02:11:14'),
(1302, 27, 'adverse_reactions', 'Yes', '2026-05-16 02:11:14', '2026-05-16 02:11:14'),
(1303, 27, 'adverse_reactions_specify', 'NA', '2026-05-16 02:11:14', '2026-05-16 02:11:14'),
(1304, 27, 'treated', 'COVID-19, Heart Murmur, Arthritis, Hepatitis B, Asthma, HIV (AIDS), Blood Disorder, Hypertension / Low BP, Anemia, Liver Disease, Leukemia, Mental Disability, Cardiovascular Disease, Renal Disease, Cancer, Rheumatic Fever, Diabetes Type I / Type II, Thyroid Disease, Emphysema, Tuberculosis, Epilepsy, Venereal Disease', '2026-05-16 02:11:14', '2026-05-16 02:11:14'),
(1305, 27, 'heavy_bleeding', 'No', '2026-05-16 02:11:14', '2026-05-16 02:11:14'),
(1306, 27, 'anything_else_know', 'Yes', '2026-05-16 02:11:14', '2026-05-16 02:11:14'),
(1307, 27, 'anything_else_know_specify', 'NA', '2026-05-16 02:11:14', '2026-05-16 02:11:14'),
(1308, 27, 'other_disease', 'No', '2026-05-16 02:11:14', '2026-05-16 02:11:14'),
(1309, 27, 'anything_about_health', 'Yes', '2026-05-16 02:11:14', '2026-05-16 02:11:14'),
(1310, 27, 'anything_about_health_specify', 'NA', '2026-05-16 02:11:14', '2026-05-16 02:11:14'),
(1311, 27, 'speak_doctor_privately', 'No', '2026-05-16 02:11:14', '2026-05-16 02:11:14'),
(1312, 27, 'date_last_complete_exam', '2026-05-03', '2026-05-16 02:11:14', '2026-05-16 02:11:14'),
(1313, 27, 'date_last_cleaning', '2026-05-05', '2026-05-16 02:11:14', '2026-05-16 02:11:14'),
(1314, 27, 'date_last_x_rays', '2026-05-07', '2026-05-16 02:11:14', '2026-05-16 02:11:14'),
(1315, 27, 'last_dentist_regularly', 'Yes', '2026-05-16 02:11:14', '2026-05-16 02:11:14'),
(1316, 27, 'last_dentist', '3 Months', '2026-05-16 02:11:14', '2026-05-16 02:11:14'),
(1317, 27, 'last_dentist_description', 'NA', '2026-05-16 02:11:14', '2026-05-16 02:11:14'),
(1318, 27, 'antibiotics', 'Yes', '2026-05-16 02:11:14', '2026-05-16 02:11:14'),
(1319, 27, 'heavy_bleeding_extractions', 'Yes', '2026-05-16 02:11:14', '2026-05-16 02:11:14'),
(1320, 27, 'gum_treatment', 'Yes', '2026-05-16 02:11:14', '2026-05-16 02:11:14'),
(1321, 27, 'orthodontic_treatment', 'Yes', '2026-05-16 02:11:14', '2026-05-16 02:11:14'),
(1322, 27, 'unpleasant_dental_experience', 'Yes', '2026-05-16 02:11:14', '2026-05-16 02:11:14'),
(1323, 27, 'age', '22', '2026-05-16 02:11:14', '2026-05-16 02:11:14'),
(1324, 27, 'pleasant_dental_experience', 'NA', '2026-05-16 02:11:14', '2026-05-16 02:11:14'),
(1325, 27, 'anything_else_should_know', 'NA', '2026-05-16 02:11:14', '2026-05-16 02:11:14'),
(1326, 27, 'brings_office_today', 'NA', '2026-05-16 02:11:14', '2026-05-16 02:11:14'),
(1327, 27, 'any_discomfort', 'Yes', '2026-05-16 02:11:14', '2026-05-16 02:11:14'),
(1328, 27, 'any_discomfort_specify', 'NA', '2026-05-16 02:11:14', '2026-05-16 02:11:14'),
(1329, 27, 'have_experienced', 'Tooth sensitivity, Bad breath, Ear ache, Headaches, Bleeding gums, Sore gums, Gagging, Missing teeth, Loose Teeth, Spaced or Crooked teeth, Unexplained nosebleed, Unsatisfactory dentures, Difficulty opening or closing, Lump or swelling in your mouth, Clench or Grind, Neck pain, Popping or clicking in the jaw joints, Thyroid Disease, Emphysema, Tuberculosis, Epilepsy, Venereal Disease', '2026-05-16 02:11:14', '2026-05-16 02:11:14'),
(1330, 27, 'food_teeth', 'Yes', '2026-05-16 02:11:14', '2026-05-16 02:11:14'),
(1331, 27, 'sore_spots', 'Yes', '2026-05-16 02:11:14', '2026-05-16 02:11:14'),
(1332, 27, 'teeth_replaced', 'Yes', '2026-05-16 02:11:14', '2026-05-16 02:11:14'),
(1333, 27, 'permanent_tooth_replacement', 'Yes', '2026-05-16 02:11:14', '2026-05-16 02:11:14'),
(1334, 27, 'local_anesthesia', 'Yes', '2026-05-16 02:11:14', '2026-05-16 02:11:14'),
(1335, 27, 'general_anesthesia', 'Yes', '2026-05-16 02:11:14', '2026-05-16 02:11:14'),
(1336, 27, 'satisfied_appearance_teeth', 'Yes', '2026-05-16 02:11:14', '2026-05-16 02:11:14'),
(1337, 27, 'keep_natural_teeth', 'Yes', '2026-05-16 02:11:14', '2026-05-16 02:11:14'),
(1338, 27, 'tense_dental_visits', 'Yes', '2026-05-16 02:11:14', '2026-05-16 02:11:14'),
(1339, 27, 'calm_nerves', 'Yes', '2026-05-16 02:11:14', '2026-05-16 02:11:14'),
(1340, 27, 'describe', 'Just for testing purpose, please ignore it.', '2026-05-16 02:11:14', '2026-05-16 02:11:14'),
(1341, 27, 'signature', 'signature_27_1778911874.png', '2026-05-16 02:11:14', '2026-05-16 02:11:14'),
(1342, 27, 'print_name', 'Vikash Kumar', '2026-05-16 02:11:14', '2026-05-16 02:11:14'),
(1343, 27, 'location', 'Burlington', '2026-05-16 02:11:14', '2026-05-16 02:11:14'),
(1344, 27, 'consent_privacy_patient', 'Yes', '2026-05-16 02:11:14', '2026-05-16 02:11:14'),
(1345, 27, 'privacy_patient_name', 'Vikash Kumar', '2026-05-16 02:11:14', '2026-05-16 02:11:14'),
(1346, 27, 'consent_newsletter', 'Yes', '2026-05-16 02:11:15', '2026-05-16 02:11:15'),
(1347, 28, 'title', 'Mr.', '2026-05-16 02:43:13', '2026-05-16 02:43:13'),
(1348, 28, 'full_name', 'Vikash Kumar', '2026-05-16 02:43:13', '2026-05-16 02:43:13'),
(1349, 28, 'sex', 'Male', '2026-05-16 02:43:13', '2026-05-16 02:43:13'),
(1350, 28, 'marital_status', 'Married', '2026-05-16 02:43:13', '2026-05-16 02:43:13'),
(1351, 28, 'date_of_birth', '2026-05-01', '2026-05-16 02:43:13', '2026-05-16 02:43:13'),
(1352, 28, 'street_address', '1155 North Service Rd W Suite 11', '2026-05-16 02:43:13', '2026-05-16 02:43:13'),
(1353, 28, 'city', 'Oakville ON', '2026-05-16 02:43:13', '2026-05-16 02:43:13'),
(1354, 28, 'province', 'Oakville', '2026-05-16 02:43:13', '2026-05-16 02:43:13'),
(1355, 28, 'postal_code', 'L6M 3E3', '2026-05-16 02:43:13', '2026-05-16 02:43:13'),
(1356, 28, 'email_address', 'vikash@tastechnologies.com', '2026-05-16 02:43:13', '2026-05-16 02:43:13'),
(1357, 28, 'home_phone', '416-578-0907', '2026-05-16 02:43:13', '2026-05-16 02:43:13'),
(1358, 28, 'cell_phone', '416-578-0907', '2026-05-16 02:43:13', '2026-05-16 02:43:13'),
(1359, 28, 'cccupation', 'NA', '2026-05-16 02:43:13', '2026-05-16 02:43:13'),
(1360, 28, 'employed_by', 'NA', '2026-05-16 02:43:13', '2026-05-16 02:43:13'),
(1361, 28, 'dental_insurance', 'Yes', '2026-05-16 02:43:13', '2026-05-16 02:43:13'),
(1362, 28, 'insurance_company', 'NA', '2026-05-16 02:43:13', '2026-05-16 02:43:13'),
(1363, 28, 'policy_no', 'NA', '2026-05-16 02:43:13', '2026-05-16 02:43:13'),
(1364, 28, 'certificate_no', 'NA', '2026-05-16 02:43:13', '2026-05-16 02:43:13'),
(1365, 28, 'family_physician', 'NA', '2026-05-16 02:43:13', '2026-05-16 02:43:13'),
(1366, 28, 'physician_phone', 'NA', '2026-05-16 02:43:13', '2026-05-16 02:43:13'),
(1367, 28, 'previous_dentist', 'NA', '2026-05-16 02:43:13', '2026-05-16 02:43:13'),
(1368, 28, 'previous_dentist_phone', 'NA', '2026-05-16 02:43:13', '2026-05-16 02:43:13'),
(1369, 28, 'referral_credit', 'NA', '2026-05-16 02:43:13', '2026-05-16 02:43:13'),
(1370, 28, 'en_contact_name', 'Vikash Kumar', '2026-05-16 02:43:13', '2026-05-16 02:43:13'),
(1371, 28, 'en_relationship', 'NA', '2026-05-16 02:43:13', '2026-05-16 02:43:13'),
(1372, 28, 'en_address', 'NA', '2026-05-16 02:43:13', '2026-05-16 02:43:13'),
(1373, 28, 'en_phone_number', 'NA', '2026-05-16 02:43:13', '2026-05-16 02:43:13'),
(1374, 28, 'dlcp_examination', '2026-05-02', '2026-05-16 02:43:13', '2026-05-16 02:43:13'),
(1375, 28, 'cup_care', 'Yes', '2026-05-16 02:43:13', '2026-05-16 02:43:13'),
(1376, 28, 'cup_care_specify', 'NA', '2026-05-16 02:43:13', '2026-05-16 02:43:13'),
(1377, 28, 'frequent_headaches', 'No', '2026-05-16 02:43:13', '2026-05-16 02:43:13'),
(1378, 28, 'smoke', 'No', '2026-05-16 02:43:13', '2026-05-16 02:43:13'),
(1379, 28, 'drink_alcohol', 'Yes', '2026-05-16 02:43:13', '2026-05-16 02:43:13'),
(1380, 28, 'drink_alcohol_specify', 'NA', '2026-05-16 02:43:13', '2026-05-16 02:43:13'),
(1381, 28, 'recreational_drugs', 'No', '2026-05-16 02:43:13', '2026-05-16 02:43:13'),
(1382, 28, 'herbal_substances', 'Yes', '2026-05-16 02:43:13', '2026-05-16 02:43:13'),
(1383, 28, 'herbal_substances_specify', 'NA', '2026-05-16 02:43:13', '2026-05-16 02:43:13'),
(1384, 28, 'any_medications', 'Yes', '2026-05-16 02:43:13', '2026-05-16 02:43:13'),
(1385, 28, 'any_medications_specify', 'NA', '2026-05-16 02:43:13', '2026-05-16 02:43:13'),
(1386, 28, 'prolonged_medication', 'Yes', '2026-05-16 02:43:13', '2026-05-16 02:43:13'),
(1387, 28, 'prolonged_medication_specify', 'NA', '2026-05-16 02:43:13', '2026-05-16 02:43:13'),
(1388, 28, 'cortisone', 'No', '2026-05-16 02:43:13', '2026-05-16 02:43:13'),
(1389, 28, 'any_surgery', 'Yes', '2026-05-16 02:43:13', '2026-05-16 02:43:13'),
(1390, 28, 'any_surgery_specify', 'NA', '2026-05-16 02:43:13', '2026-05-16 02:43:13'),
(1391, 28, 'ankles_swollen', 'No', '2026-05-16 02:43:13', '2026-05-16 02:43:13'),
(1392, 28, 'gained_lost_weight', 'No', '2026-05-16 02:43:13', '2026-05-16 02:43:13'),
(1393, 28, 'pregnant', 'Yes', '2026-05-16 02:43:13', '2026-05-16 02:43:13'),
(1394, 28, 'pregnant_weeks', '3 Months', '2026-05-16 02:43:13', '2026-05-16 02:43:13'),
(1395, 28, 'adverse_reaction', 'Latex, Penicillin, Metals, Sulfa Drugs', '2026-05-16 02:43:13', '2026-05-16 02:43:13'),
(1396, 28, 'allergic_adverse_reaction', 'Aspirin, Local Anesthetic (Freezing), Barbiturates (Sleeping pills), Nitrous Oxide, Codeine', '2026-05-16 02:43:13', '2026-05-16 02:43:13'),
(1397, 28, 'adverse_reactions', 'Yes', '2026-05-16 02:43:13', '2026-05-16 02:43:13'),
(1398, 28, 'adverse_reactions_specify', 'NA', '2026-05-16 02:43:13', '2026-05-16 02:43:13'),
(1399, 28, 'treated', 'COVID-19, Heart Murmur, Arthritis, Hepatitis B, Asthma, HIV (AIDS), Blood Disorder, Hypertension / Low BP, Anemia, Liver Disease, Leukemia, Mental Disability, Cardiovascular Disease, Renal Disease, Cancer, Rheumatic Fever, Diabetes Type I / Type II, Thyroid Disease, Emphysema, Tuberculosis, Epilepsy, Venereal Disease', '2026-05-16 02:43:13', '2026-05-16 02:43:13'),
(1400, 28, 'heavy_bleeding', 'Yes', '2026-05-16 02:43:13', '2026-05-16 02:43:13'),
(1401, 28, 'anything_else_know', 'Yes', '2026-05-16 02:43:13', '2026-05-16 02:43:13'),
(1402, 28, 'anything_else_know_specify', 'NA', '2026-05-16 02:43:13', '2026-05-16 02:43:13'),
(1403, 28, 'other_disease', 'Yes', '2026-05-16 02:43:13', '2026-05-16 02:43:13'),
(1404, 28, 'anything_about_health', 'Yes', '2026-05-16 02:43:13', '2026-05-16 02:43:13'),
(1405, 28, 'anything_about_health_specify', 'NA', '2026-05-16 02:43:13', '2026-05-16 02:43:13'),
(1406, 28, 'speak_doctor_privately', 'Yes', '2026-05-16 02:43:13', '2026-05-16 02:43:13'),
(1407, 28, 'date_last_complete_exam', '2026-05-04', '2026-05-16 02:43:13', '2026-05-16 02:43:13'),
(1408, 28, 'date_last_cleaning', '2026-05-05', '2026-05-16 02:43:13', '2026-05-16 02:43:13'),
(1409, 28, 'date_last_x_rays', '2026-05-06', '2026-05-16 02:43:13', '2026-05-16 02:43:13'),
(1410, 28, 'last_dentist_regularly', 'Yes', '2026-05-16 02:43:13', '2026-05-16 02:43:13'),
(1411, 28, 'last_dentist', '3 Months', '2026-05-16 02:43:13', '2026-05-16 02:43:13'),
(1412, 28, 'last_dentist_description', 'NA', '2026-05-16 02:43:13', '2026-05-16 02:43:13'),
(1413, 28, 'antibiotics', 'Yes', '2026-05-16 02:43:13', '2026-05-16 02:43:13'),
(1414, 28, 'heavy_bleeding_extractions', 'Yes', '2026-05-16 02:43:13', '2026-05-16 02:43:13'),
(1415, 28, 'gum_treatment', 'Yes', '2026-05-16 02:43:13', '2026-05-16 02:43:13'),
(1416, 28, 'orthodontic_treatment', 'Yes', '2026-05-16 02:43:13', '2026-05-16 02:43:13');
INSERT INTO `cdt_form_submission_values` (`id`, `submission_id`, `field_name`, `field_value`, `created_at`, `updated_at`) VALUES
(1417, 28, 'unpleasant_dental_experience', 'Yes', '2026-05-16 02:43:13', '2026-05-16 02:43:13'),
(1418, 28, 'age', '22', '2026-05-16 02:43:13', '2026-05-16 02:43:13'),
(1419, 28, 'pleasant_dental_experience', 'NA', '2026-05-16 02:43:13', '2026-05-16 02:43:13'),
(1420, 28, 'anything_else_should_know', 'NA', '2026-05-16 02:43:13', '2026-05-16 02:43:13'),
(1421, 28, 'brings_office_today', 'NA', '2026-05-16 02:43:13', '2026-05-16 02:43:13'),
(1422, 28, 'any_discomfort', 'Yes', '2026-05-16 02:43:13', '2026-05-16 02:43:13'),
(1423, 28, 'any_discomfort_specify', 'NA', '2026-05-16 02:43:13', '2026-05-16 02:43:13'),
(1424, 28, 'have_experienced', 'Tooth sensitivity, Bad breath, Ear ache, Headaches, Bleeding gums, Sore gums, Gagging, Missing teeth, Loose Teeth, Spaced or Crooked teeth, Unexplained nosebleed, Unsatisfactory dentures, Difficulty opening or closing, Lump or swelling in your mouth, Clench or Grind, Neck pain, Popping or clicking in the jaw joints, Thyroid Disease, Emphysema, Tuberculosis, Epilepsy, Venereal Disease', '2026-05-16 02:43:13', '2026-05-16 02:43:13'),
(1425, 28, 'food_teeth', 'Yes', '2026-05-16 02:43:13', '2026-05-16 02:43:13'),
(1426, 28, 'sore_spots', 'Yes', '2026-05-16 02:43:13', '2026-05-16 02:43:13'),
(1427, 28, 'teeth_replaced', 'Yes', '2026-05-16 02:43:13', '2026-05-16 02:43:13'),
(1428, 28, 'permanent_tooth_replacement', 'Yes', '2026-05-16 02:43:13', '2026-05-16 02:43:13'),
(1429, 28, 'local_anesthesia', 'Yes', '2026-05-16 02:43:13', '2026-05-16 02:43:13'),
(1430, 28, 'general_anesthesia', 'Yes', '2026-05-16 02:43:13', '2026-05-16 02:43:13'),
(1431, 28, 'satisfied_appearance_teeth', 'Yes', '2026-05-16 02:43:13', '2026-05-16 02:43:13'),
(1432, 28, 'keep_natural_teeth', 'Yes', '2026-05-16 02:43:13', '2026-05-16 02:43:13'),
(1433, 28, 'tense_dental_visits', 'Yes', '2026-05-16 02:43:13', '2026-05-16 02:43:13'),
(1434, 28, 'calm_nerves', 'Yes', '2026-05-16 02:43:13', '2026-05-16 02:43:13'),
(1435, 28, 'describe', 'Just for testing purpose, please ignore it.', '2026-05-16 02:43:13', '2026-05-16 02:43:13'),
(1436, 28, 'signature', 'signature_28_1778913793.png', '2026-05-16 02:43:13', '2026-05-16 02:43:13'),
(1437, 28, 'print_name', 'Vikash Kumar', '2026-05-16 02:43:13', '2026-05-16 02:43:13'),
(1438, 28, 'location', 'Oakville', '2026-05-16 02:43:13', '2026-05-16 02:43:13'),
(1439, 28, 'consent_privacy_patient', 'Yes', '2026-05-16 02:43:13', '2026-05-16 02:43:13'),
(1440, 28, 'privacy_patient_name', 'Vikash Kumar', '2026-05-16 02:43:13', '2026-05-16 02:43:13'),
(1441, 28, 'consent_newsletter', NULL, '2026-05-16 02:43:13', '2026-05-16 02:43:13'),
(1442, 29, 'title', 'Mr.', '2026-05-16 02:57:45', '2026-05-16 02:57:45'),
(1443, 29, 'full_name', 'Vikash Kumar', '2026-05-16 02:57:45', '2026-05-16 02:57:45'),
(1444, 29, 'sex', 'Male', '2026-05-16 02:57:45', '2026-05-16 02:57:45'),
(1445, 29, 'marital_status', 'Married', '2026-05-16 02:57:45', '2026-05-16 02:57:45'),
(1446, 29, 'date_of_birth', '2026-05-01', '2026-05-16 02:57:45', '2026-05-16 02:57:45'),
(1447, 29, 'street_address', '1155 North Service Rd W Suite 11', '2026-05-16 02:57:45', '2026-05-16 02:57:45'),
(1448, 29, 'city', 'Oakville ON', '2026-05-16 02:57:45', '2026-05-16 02:57:45'),
(1449, 29, 'province', 'Oakville', '2026-05-16 02:57:45', '2026-05-16 02:57:45'),
(1450, 29, 'postal_code', 'L6M 3E3', '2026-05-16 02:57:45', '2026-05-16 02:57:45'),
(1451, 29, 'email_address', 'vikash@tastechnologies.com', '2026-05-16 02:57:45', '2026-05-16 02:57:45'),
(1452, 29, 'home_phone', NULL, '2026-05-16 02:57:45', '2026-05-16 02:57:45'),
(1453, 29, 'cell_phone', '416-578-0907', '2026-05-16 02:57:45', '2026-05-16 02:57:45'),
(1454, 29, 'cccupation', NULL, '2026-05-16 02:57:45', '2026-05-16 02:57:45'),
(1455, 29, 'employed_by', NULL, '2026-05-16 02:57:45', '2026-05-16 02:57:45'),
(1456, 29, 'dental_insurance', NULL, '2026-05-16 02:57:45', '2026-05-16 02:57:45'),
(1457, 29, 'insurance_company', NULL, '2026-05-16 02:57:45', '2026-05-16 02:57:45'),
(1458, 29, 'policy_no', NULL, '2026-05-16 02:57:45', '2026-05-16 02:57:45'),
(1459, 29, 'certificate_no', NULL, '2026-05-16 02:57:45', '2026-05-16 02:57:45'),
(1460, 29, 'family_physician', NULL, '2026-05-16 02:57:45', '2026-05-16 02:57:45'),
(1461, 29, 'physician_phone', NULL, '2026-05-16 02:57:45', '2026-05-16 02:57:45'),
(1462, 29, 'previous_dentist', NULL, '2026-05-16 02:57:45', '2026-05-16 02:57:45'),
(1463, 29, 'previous_dentist_phone', NULL, '2026-05-16 02:57:45', '2026-05-16 02:57:45'),
(1464, 29, 'referral_credit', NULL, '2026-05-16 02:57:45', '2026-05-16 02:57:45'),
(1465, 29, 'en_contact_name', NULL, '2026-05-16 02:57:45', '2026-05-16 02:57:45'),
(1466, 29, 'en_relationship', NULL, '2026-05-16 02:57:45', '2026-05-16 02:57:45'),
(1467, 29, 'en_address', NULL, '2026-05-16 02:57:45', '2026-05-16 02:57:45'),
(1468, 29, 'en_phone_number', NULL, '2026-05-16 02:57:45', '2026-05-16 02:57:45'),
(1469, 29, 'dlcp_examination', NULL, '2026-05-16 02:57:45', '2026-05-16 02:57:45'),
(1470, 29, 'cup_care', NULL, '2026-05-16 02:57:45', '2026-05-16 02:57:45'),
(1471, 29, 'cup_care_specify', NULL, '2026-05-16 02:57:45', '2026-05-16 02:57:45'),
(1472, 29, 'frequent_headaches', NULL, '2026-05-16 02:57:45', '2026-05-16 02:57:45'),
(1473, 29, 'smoke', NULL, '2026-05-16 02:57:45', '2026-05-16 02:57:45'),
(1474, 29, 'drink_alcohol', NULL, '2026-05-16 02:57:45', '2026-05-16 02:57:45'),
(1475, 29, 'drink_alcohol_specify', NULL, '2026-05-16 02:57:45', '2026-05-16 02:57:45'),
(1476, 29, 'recreational_drugs', NULL, '2026-05-16 02:57:45', '2026-05-16 02:57:45'),
(1477, 29, 'herbal_substances', NULL, '2026-05-16 02:57:45', '2026-05-16 02:57:45'),
(1478, 29, 'herbal_substances_specify', NULL, '2026-05-16 02:57:45', '2026-05-16 02:57:45'),
(1479, 29, 'any_medications', NULL, '2026-05-16 02:57:45', '2026-05-16 02:57:45'),
(1480, 29, 'any_medications_specify', NULL, '2026-05-16 02:57:45', '2026-05-16 02:57:45'),
(1481, 29, 'prolonged_medication', NULL, '2026-05-16 02:57:45', '2026-05-16 02:57:45'),
(1482, 29, 'prolonged_medication_specify', NULL, '2026-05-16 02:57:45', '2026-05-16 02:57:45'),
(1483, 29, 'cortisone', NULL, '2026-05-16 02:57:45', '2026-05-16 02:57:45'),
(1484, 29, 'any_surgery', NULL, '2026-05-16 02:57:45', '2026-05-16 02:57:45'),
(1485, 29, 'any_surgery_specify', NULL, '2026-05-16 02:57:45', '2026-05-16 02:57:45'),
(1486, 29, 'ankles_swollen', NULL, '2026-05-16 02:57:45', '2026-05-16 02:57:45'),
(1487, 29, 'gained_lost_weight', NULL, '2026-05-16 02:57:45', '2026-05-16 02:57:45'),
(1488, 29, 'pregnant', NULL, '2026-05-16 02:57:45', '2026-05-16 02:57:45'),
(1489, 29, 'pregnant_weeks', NULL, '2026-05-16 02:57:45', '2026-05-16 02:57:45'),
(1490, 29, 'adverse_reaction', NULL, '2026-05-16 02:57:45', '2026-05-16 02:57:45'),
(1491, 29, 'allergic_adverse_reaction', NULL, '2026-05-16 02:57:45', '2026-05-16 02:57:45'),
(1492, 29, 'adverse_reactions', NULL, '2026-05-16 02:57:45', '2026-05-16 02:57:45'),
(1493, 29, 'adverse_reactions_specify', NULL, '2026-05-16 02:57:45', '2026-05-16 02:57:45'),
(1494, 29, 'treated', NULL, '2026-05-16 02:57:45', '2026-05-16 02:57:45'),
(1495, 29, 'heavy_bleeding', NULL, '2026-05-16 02:57:45', '2026-05-16 02:57:45'),
(1496, 29, 'anything_else_know', NULL, '2026-05-16 02:57:45', '2026-05-16 02:57:45'),
(1497, 29, 'anything_else_know_specify', NULL, '2026-05-16 02:57:45', '2026-05-16 02:57:45'),
(1498, 29, 'other_disease', NULL, '2026-05-16 02:57:45', '2026-05-16 02:57:45'),
(1499, 29, 'anything_about_health', NULL, '2026-05-16 02:57:45', '2026-05-16 02:57:45'),
(1500, 29, 'anything_about_health_specify', NULL, '2026-05-16 02:57:45', '2026-05-16 02:57:45'),
(1501, 29, 'speak_doctor_privately', NULL, '2026-05-16 02:57:45', '2026-05-16 02:57:45'),
(1502, 29, 'date_last_complete_exam', NULL, '2026-05-16 02:57:45', '2026-05-16 02:57:45'),
(1503, 29, 'date_last_cleaning', NULL, '2026-05-16 02:57:45', '2026-05-16 02:57:45'),
(1504, 29, 'date_last_x_rays', NULL, '2026-05-16 02:57:45', '2026-05-16 02:57:45'),
(1505, 29, 'last_dentist_regularly', NULL, '2026-05-16 02:57:45', '2026-05-16 02:57:45'),
(1506, 29, 'last_dentist', NULL, '2026-05-16 02:57:45', '2026-05-16 02:57:45'),
(1507, 29, 'last_dentist_description', NULL, '2026-05-16 02:57:45', '2026-05-16 02:57:45'),
(1508, 29, 'antibiotics', NULL, '2026-05-16 02:57:45', '2026-05-16 02:57:45'),
(1509, 29, 'heavy_bleeding_extractions', NULL, '2026-05-16 02:57:45', '2026-05-16 02:57:45'),
(1510, 29, 'gum_treatment', NULL, '2026-05-16 02:57:45', '2026-05-16 02:57:45'),
(1511, 29, 'orthodontic_treatment', NULL, '2026-05-16 02:57:45', '2026-05-16 02:57:45'),
(1512, 29, 'unpleasant_dental_experience', NULL, '2026-05-16 02:57:45', '2026-05-16 02:57:45'),
(1513, 29, 'age', '22', '2026-05-16 02:57:45', '2026-05-16 02:57:45'),
(1514, 29, 'pleasant_dental_experience', NULL, '2026-05-16 02:57:45', '2026-05-16 02:57:45'),
(1515, 29, 'anything_else_should_know', NULL, '2026-05-16 02:57:45', '2026-05-16 02:57:45'),
(1516, 29, 'brings_office_today', NULL, '2026-05-16 02:57:45', '2026-05-16 02:57:45'),
(1517, 29, 'any_discomfort', NULL, '2026-05-16 02:57:45', '2026-05-16 02:57:45'),
(1518, 29, 'any_discomfort_specify', NULL, '2026-05-16 02:57:45', '2026-05-16 02:57:45'),
(1519, 29, 'have_experienced', NULL, '2026-05-16 02:57:45', '2026-05-16 02:57:45'),
(1520, 29, 'food_teeth', NULL, '2026-05-16 02:57:45', '2026-05-16 02:57:45'),
(1521, 29, 'sore_spots', NULL, '2026-05-16 02:57:45', '2026-05-16 02:57:45'),
(1522, 29, 'teeth_replaced', NULL, '2026-05-16 02:57:45', '2026-05-16 02:57:45'),
(1523, 29, 'permanent_tooth_replacement', NULL, '2026-05-16 02:57:45', '2026-05-16 02:57:45'),
(1524, 29, 'local_anesthesia', NULL, '2026-05-16 02:57:45', '2026-05-16 02:57:45'),
(1525, 29, 'general_anesthesia', NULL, '2026-05-16 02:57:45', '2026-05-16 02:57:45'),
(1526, 29, 'satisfied_appearance_teeth', NULL, '2026-05-16 02:57:45', '2026-05-16 02:57:45'),
(1527, 29, 'keep_natural_teeth', NULL, '2026-05-16 02:57:45', '2026-05-16 02:57:45'),
(1528, 29, 'tense_dental_visits', NULL, '2026-05-16 02:57:45', '2026-05-16 02:57:45'),
(1529, 29, 'calm_nerves', NULL, '2026-05-16 02:57:45', '2026-05-16 02:57:45'),
(1530, 29, 'describe', 'Just for testing purpose, please ignore it.', '2026-05-16 02:57:45', '2026-05-16 02:57:45'),
(1531, 29, 'signature', 'signature_29_1778914665.png', '2026-05-16 02:57:45', '2026-05-16 02:57:45'),
(1532, 29, 'print_name', 'Vikash Kumar', '2026-05-16 02:57:45', '2026-05-16 02:57:45'),
(1533, 29, 'location', 'Mississauga', '2026-05-16 02:57:45', '2026-05-16 02:57:45'),
(1534, 29, 'consent_privacy_patient', 'Yes', '2026-05-16 02:57:45', '2026-05-16 02:57:45'),
(1535, 29, 'privacy_patient_name', 'Vikash Kumar', '2026-05-16 02:57:45', '2026-05-16 02:57:45'),
(1536, 29, 'consent_newsletter', 'Yes', '2026-05-16 02:57:45', '2026-05-16 02:57:45'),
(1537, 30, 'title', NULL, '2026-05-18 06:22:24', '2026-05-18 06:22:24'),
(1538, 30, 'full_name', 'Vikash Kumar', '2026-05-18 06:22:24', '2026-05-18 06:22:24'),
(1539, 30, 'sex', 'Male', '2026-05-18 06:22:24', '2026-05-18 06:22:24'),
(1540, 30, 'marital_status', 'Married', '2026-05-18 06:22:24', '2026-05-18 06:22:24'),
(1541, 30, 'date_of_birth', '2026-05-08', '2026-05-18 06:22:24', '2026-05-18 06:22:24'),
(1542, 30, 'street_address', '1155 North Service Rd W Suite 11', '2026-05-18 06:22:24', '2026-05-18 06:22:24'),
(1543, 30, 'city', 'Oakville ON', '2026-05-18 06:22:25', '2026-05-18 06:22:25'),
(1544, 30, 'province', 'Oakville', '2026-05-18 06:22:25', '2026-05-18 06:22:25'),
(1545, 30, 'postal_code', 'L6M 3E3', '2026-05-18 06:22:25', '2026-05-18 06:22:25'),
(1546, 30, 'email_address', 'vikash@tastechnologies.com', '2026-05-18 06:22:25', '2026-05-18 06:22:25'),
(1547, 30, 'home_phone', NULL, '2026-05-18 06:22:25', '2026-05-18 06:22:25'),
(1548, 30, 'cell_phone', '416-578-0907', '2026-05-18 06:22:25', '2026-05-18 06:22:25'),
(1549, 30, 'cccupation', NULL, '2026-05-18 06:22:25', '2026-05-18 06:22:25'),
(1550, 30, 'employed_by', NULL, '2026-05-18 06:22:25', '2026-05-18 06:22:25'),
(1551, 30, 'dental_insurance', NULL, '2026-05-18 06:22:25', '2026-05-18 06:22:25'),
(1552, 30, 'insurance_company', NULL, '2026-05-18 06:22:25', '2026-05-18 06:22:25'),
(1553, 30, 'policy_no', NULL, '2026-05-18 06:22:25', '2026-05-18 06:22:25'),
(1554, 30, 'certificate_no', NULL, '2026-05-18 06:22:25', '2026-05-18 06:22:25'),
(1555, 30, 'family_physician', NULL, '2026-05-18 06:22:25', '2026-05-18 06:22:25'),
(1556, 30, 'physician_phone', NULL, '2026-05-18 06:22:25', '2026-05-18 06:22:25'),
(1557, 30, 'previous_dentist', NULL, '2026-05-18 06:22:25', '2026-05-18 06:22:25'),
(1558, 30, 'previous_dentist_phone', NULL, '2026-05-18 06:22:25', '2026-05-18 06:22:25'),
(1559, 30, 'referral_credit', NULL, '2026-05-18 06:22:25', '2026-05-18 06:22:25'),
(1560, 30, 'en_contact_name', NULL, '2026-05-18 06:22:25', '2026-05-18 06:22:25'),
(1561, 30, 'en_relationship', NULL, '2026-05-18 06:22:25', '2026-05-18 06:22:25'),
(1562, 30, 'en_address', NULL, '2026-05-18 06:22:25', '2026-05-18 06:22:25'),
(1563, 30, 'en_phone_number', NULL, '2026-05-18 06:22:25', '2026-05-18 06:22:25'),
(1564, 30, 'dlcp_examination', NULL, '2026-05-18 06:22:25', '2026-05-18 06:22:25'),
(1565, 30, 'cup_care', NULL, '2026-05-18 06:22:25', '2026-05-18 06:22:25'),
(1566, 30, 'cup_care_specify', NULL, '2026-05-18 06:22:25', '2026-05-18 06:22:25'),
(1567, 30, 'frequent_headaches', NULL, '2026-05-18 06:22:25', '2026-05-18 06:22:25'),
(1568, 30, 'smoke', NULL, '2026-05-18 06:22:25', '2026-05-18 06:22:25'),
(1569, 30, 'drink_alcohol', NULL, '2026-05-18 06:22:25', '2026-05-18 06:22:25'),
(1570, 30, 'drink_alcohol_specify', NULL, '2026-05-18 06:22:25', '2026-05-18 06:22:25'),
(1571, 30, 'recreational_drugs', NULL, '2026-05-18 06:22:25', '2026-05-18 06:22:25'),
(1572, 30, 'herbal_substances', NULL, '2026-05-18 06:22:25', '2026-05-18 06:22:25'),
(1573, 30, 'herbal_substances_specify', NULL, '2026-05-18 06:22:25', '2026-05-18 06:22:25'),
(1574, 30, 'any_medications', NULL, '2026-05-18 06:22:25', '2026-05-18 06:22:25'),
(1575, 30, 'any_medications_specify', NULL, '2026-05-18 06:22:25', '2026-05-18 06:22:25'),
(1576, 30, 'prolonged_medication', NULL, '2026-05-18 06:22:25', '2026-05-18 06:22:25'),
(1577, 30, 'prolonged_medication_specify', NULL, '2026-05-18 06:22:25', '2026-05-18 06:22:25'),
(1578, 30, 'cortisone', NULL, '2026-05-18 06:22:25', '2026-05-18 06:22:25'),
(1579, 30, 'any_surgery', NULL, '2026-05-18 06:22:25', '2026-05-18 06:22:25'),
(1580, 30, 'any_surgery_specify', NULL, '2026-05-18 06:22:25', '2026-05-18 06:22:25'),
(1581, 30, 'ankles_swollen', NULL, '2026-05-18 06:22:25', '2026-05-18 06:22:25'),
(1582, 30, 'gained_lost_weight', NULL, '2026-05-18 06:22:25', '2026-05-18 06:22:25'),
(1583, 30, 'pregnant', NULL, '2026-05-18 06:22:25', '2026-05-18 06:22:25'),
(1584, 30, 'pregnant_weeks', NULL, '2026-05-18 06:22:25', '2026-05-18 06:22:25'),
(1585, 30, 'adverse_reaction', NULL, '2026-05-18 06:22:25', '2026-05-18 06:22:25'),
(1586, 30, 'allergic_adverse_reaction', NULL, '2026-05-18 06:22:25', '2026-05-18 06:22:25'),
(1587, 30, 'adverse_reactions', NULL, '2026-05-18 06:22:25', '2026-05-18 06:22:25'),
(1588, 30, 'adverse_reactions_specify', NULL, '2026-05-18 06:22:25', '2026-05-18 06:22:25'),
(1589, 30, 'treated', NULL, '2026-05-18 06:22:25', '2026-05-18 06:22:25'),
(1590, 30, 'heavy_bleeding', NULL, '2026-05-18 06:22:25', '2026-05-18 06:22:25'),
(1591, 30, 'anything_else_know', NULL, '2026-05-18 06:22:25', '2026-05-18 06:22:25'),
(1592, 30, 'anything_else_know_specify', NULL, '2026-05-18 06:22:25', '2026-05-18 06:22:25'),
(1593, 30, 'other_disease', NULL, '2026-05-18 06:22:25', '2026-05-18 06:22:25'),
(1594, 30, 'anything_about_health', NULL, '2026-05-18 06:22:25', '2026-05-18 06:22:25'),
(1595, 30, 'anything_about_health_specify', NULL, '2026-05-18 06:22:25', '2026-05-18 06:22:25'),
(1596, 30, 'speak_doctor_privately', NULL, '2026-05-18 06:22:25', '2026-05-18 06:22:25'),
(1597, 30, 'date_last_complete_exam', NULL, '2026-05-18 06:22:25', '2026-05-18 06:22:25'),
(1598, 30, 'date_last_cleaning', NULL, '2026-05-18 06:22:25', '2026-05-18 06:22:25'),
(1599, 30, 'date_last_x_rays', NULL, '2026-05-18 06:22:25', '2026-05-18 06:22:25'),
(1600, 30, 'last_dentist_regularly', NULL, '2026-05-18 06:22:25', '2026-05-18 06:22:25'),
(1601, 30, 'last_dentist', NULL, '2026-05-18 06:22:25', '2026-05-18 06:22:25'),
(1602, 30, 'last_dentist_description', NULL, '2026-05-18 06:22:25', '2026-05-18 06:22:25'),
(1603, 30, 'antibiotics', NULL, '2026-05-18 06:22:25', '2026-05-18 06:22:25'),
(1604, 30, 'heavy_bleeding_extractions', NULL, '2026-05-18 06:22:25', '2026-05-18 06:22:25'),
(1605, 30, 'gum_treatment', NULL, '2026-05-18 06:22:25', '2026-05-18 06:22:25'),
(1606, 30, 'orthodontic_treatment', NULL, '2026-05-18 06:22:25', '2026-05-18 06:22:25'),
(1607, 30, 'unpleasant_dental_experience', NULL, '2026-05-18 06:22:25', '2026-05-18 06:22:25'),
(1608, 30, 'age', '22', '2026-05-18 06:22:25', '2026-05-18 06:22:25'),
(1609, 30, 'pleasant_dental_experience', NULL, '2026-05-18 06:22:25', '2026-05-18 06:22:25'),
(1610, 30, 'anything_else_should_know', NULL, '2026-05-18 06:22:25', '2026-05-18 06:22:25'),
(1611, 30, 'brings_office_today', NULL, '2026-05-18 06:22:25', '2026-05-18 06:22:25'),
(1612, 30, 'any_discomfort', NULL, '2026-05-18 06:22:25', '2026-05-18 06:22:25'),
(1613, 30, 'any_discomfort_specify', NULL, '2026-05-18 06:22:25', '2026-05-18 06:22:25'),
(1614, 30, 'have_experienced', NULL, '2026-05-18 06:22:25', '2026-05-18 06:22:25'),
(1615, 30, 'food_teeth', NULL, '2026-05-18 06:22:25', '2026-05-18 06:22:25'),
(1616, 30, 'sore_spots', NULL, '2026-05-18 06:22:25', '2026-05-18 06:22:25'),
(1617, 30, 'teeth_replaced', NULL, '2026-05-18 06:22:25', '2026-05-18 06:22:25'),
(1618, 30, 'permanent_tooth_replacement', NULL, '2026-05-18 06:22:25', '2026-05-18 06:22:25'),
(1619, 30, 'local_anesthesia', NULL, '2026-05-18 06:22:25', '2026-05-18 06:22:25'),
(1620, 30, 'general_anesthesia', NULL, '2026-05-18 06:22:25', '2026-05-18 06:22:25'),
(1621, 30, 'satisfied_appearance_teeth', NULL, '2026-05-18 06:22:25', '2026-05-18 06:22:25'),
(1622, 30, 'keep_natural_teeth', NULL, '2026-05-18 06:22:25', '2026-05-18 06:22:25'),
(1623, 30, 'tense_dental_visits', NULL, '2026-05-18 06:22:25', '2026-05-18 06:22:25'),
(1624, 30, 'calm_nerves', NULL, '2026-05-18 06:22:25', '2026-05-18 06:22:25'),
(1625, 30, 'describe', 'Just for testing purpose, please ignore it.', '2026-05-18 06:22:25', '2026-05-18 06:22:25'),
(1626, 30, 'signature', 'signature_30_1779099744.png', '2026-05-18 06:22:25', '2026-05-18 06:22:25'),
(1627, 30, 'print_name', 'Vikash Kumar', '2026-05-18 06:22:25', '2026-05-18 06:22:25'),
(1628, 30, 'location', 'Burlington', '2026-05-18 06:22:25', '2026-05-18 06:22:25'),
(1629, 30, 'consent_privacy_patient', 'Yes', '2026-05-18 06:22:25', '2026-05-18 06:22:25'),
(1630, 30, 'privacy_patient_name', 'Vikash Kumar', '2026-05-18 06:22:25', '2026-05-18 06:22:25'),
(1631, 30, 'consent_newsletter', NULL, '2026-05-18 06:22:25', '2026-05-18 06:22:25'),
(1632, 31, 'title', 'Mr.', '2026-05-18 06:32:39', '2026-05-18 06:32:39'),
(1633, 31, 'full_name', 'Vikash Kumar', '2026-05-18 06:32:39', '2026-05-18 06:32:39'),
(1634, 31, 'sex', 'Male', '2026-05-18 06:32:39', '2026-05-18 06:32:39'),
(1635, 31, 'marital_status', 'Married', '2026-05-18 06:32:39', '2026-05-18 06:32:39'),
(1636, 31, 'date_of_birth', '2026-05-06', '2026-05-18 06:32:39', '2026-05-18 06:32:39'),
(1637, 31, 'street_address', '1155 North Service Rd W Suite 11', '2026-05-18 06:32:39', '2026-05-18 06:32:39'),
(1638, 31, 'city', 'Oakville ON', '2026-05-18 06:32:39', '2026-05-18 06:32:39'),
(1639, 31, 'province', 'Oakville', '2026-05-18 06:32:39', '2026-05-18 06:32:39'),
(1640, 31, 'postal_code', 'L6M 3E3', '2026-05-18 06:32:39', '2026-05-18 06:32:39'),
(1641, 31, 'email_address', 'vikashfsdev@gmail.com', '2026-05-18 06:32:39', '2026-05-18 06:32:39'),
(1642, 31, 'home_phone', NULL, '2026-05-18 06:32:39', '2026-05-18 06:32:39'),
(1643, 31, 'cell_phone', '416-578-0907', '2026-05-18 06:32:39', '2026-05-18 06:32:39'),
(1644, 31, 'cccupation', NULL, '2026-05-18 06:32:39', '2026-05-18 06:32:39'),
(1645, 31, 'employed_by', NULL, '2026-05-18 06:32:39', '2026-05-18 06:32:39'),
(1646, 31, 'dental_insurance', NULL, '2026-05-18 06:32:39', '2026-05-18 06:32:39'),
(1647, 31, 'insurance_company', NULL, '2026-05-18 06:32:39', '2026-05-18 06:32:39'),
(1648, 31, 'policy_no', NULL, '2026-05-18 06:32:39', '2026-05-18 06:32:39'),
(1649, 31, 'certificate_no', NULL, '2026-05-18 06:32:39', '2026-05-18 06:32:39'),
(1650, 31, 'family_physician', NULL, '2026-05-18 06:32:39', '2026-05-18 06:32:39'),
(1651, 31, 'physician_phone', NULL, '2026-05-18 06:32:39', '2026-05-18 06:32:39'),
(1652, 31, 'previous_dentist', NULL, '2026-05-18 06:32:39', '2026-05-18 06:32:39'),
(1653, 31, 'previous_dentist_phone', NULL, '2026-05-18 06:32:39', '2026-05-18 06:32:39'),
(1654, 31, 'referral_credit', NULL, '2026-05-18 06:32:39', '2026-05-18 06:32:39'),
(1655, 31, 'en_contact_name', NULL, '2026-05-18 06:32:39', '2026-05-18 06:32:39'),
(1656, 31, 'en_relationship', NULL, '2026-05-18 06:32:39', '2026-05-18 06:32:39'),
(1657, 31, 'en_address', NULL, '2026-05-18 06:32:39', '2026-05-18 06:32:39'),
(1658, 31, 'en_phone_number', NULL, '2026-05-18 06:32:39', '2026-05-18 06:32:39'),
(1659, 31, 'dlcp_examination', '2026-05-19', '2026-05-18 06:32:39', '2026-05-18 06:32:39'),
(1660, 31, 'cup_care', NULL, '2026-05-18 06:32:39', '2026-05-18 06:32:39'),
(1661, 31, 'cup_care_specify', NULL, '2026-05-18 06:32:39', '2026-05-18 06:32:39'),
(1662, 31, 'frequent_headaches', NULL, '2026-05-18 06:32:39', '2026-05-18 06:32:39'),
(1663, 31, 'smoke', NULL, '2026-05-18 06:32:39', '2026-05-18 06:32:39'),
(1664, 31, 'drink_alcohol', 'Yes', '2026-05-18 06:32:39', '2026-05-18 06:32:39'),
(1665, 31, 'drink_alcohol_specify', 'NA', '2026-05-18 06:32:39', '2026-05-18 06:32:39'),
(1666, 31, 'recreational_drugs', NULL, '2026-05-18 06:32:39', '2026-05-18 06:32:39'),
(1667, 31, 'herbal_substances', NULL, '2026-05-18 06:32:39', '2026-05-18 06:32:39'),
(1668, 31, 'herbal_substances_specify', NULL, '2026-05-18 06:32:39', '2026-05-18 06:32:39'),
(1669, 31, 'any_medications', NULL, '2026-05-18 06:32:39', '2026-05-18 06:32:39'),
(1670, 31, 'any_medications_specify', NULL, '2026-05-18 06:32:39', '2026-05-18 06:32:39'),
(1671, 31, 'prolonged_medication', NULL, '2026-05-18 06:32:39', '2026-05-18 06:32:39'),
(1672, 31, 'prolonged_medication_specify', NULL, '2026-05-18 06:32:39', '2026-05-18 06:32:39'),
(1673, 31, 'cortisone', NULL, '2026-05-18 06:32:39', '2026-05-18 06:32:39'),
(1674, 31, 'any_surgery', NULL, '2026-05-18 06:32:39', '2026-05-18 06:32:39'),
(1675, 31, 'any_surgery_specify', NULL, '2026-05-18 06:32:39', '2026-05-18 06:32:39'),
(1676, 31, 'ankles_swollen', NULL, '2026-05-18 06:32:39', '2026-05-18 06:32:39'),
(1677, 31, 'gained_lost_weight', NULL, '2026-05-18 06:32:39', '2026-05-18 06:32:39'),
(1678, 31, 'pregnant', 'Yes', '2026-05-18 06:32:39', '2026-05-18 06:32:39'),
(1679, 31, 'pregnant_weeks', '3 Months', '2026-05-18 06:32:39', '2026-05-18 06:32:39'),
(1680, 31, 'adverse_reaction', 'Latex, Metals', '2026-05-18 06:32:39', '2026-05-18 06:32:39'),
(1681, 31, 'allergic_adverse_reaction', 'Aspirin, Local Anesthetic (Freezing), Codeine', '2026-05-18 06:32:39', '2026-05-18 06:32:39'),
(1682, 31, 'adverse_reactions', NULL, '2026-05-18 06:32:39', '2026-05-18 06:32:39'),
(1683, 31, 'adverse_reactions_specify', NULL, '2026-05-18 06:32:39', '2026-05-18 06:32:39'),
(1684, 31, 'treated', 'COVID-19, Heart Murmur, Hepatitis B, Asthma, Cardiovascular Disease, Emphysema, Tuberculosis', '2026-05-18 06:32:39', '2026-05-18 06:32:39'),
(1685, 31, 'heavy_bleeding', NULL, '2026-05-18 06:32:39', '2026-05-18 06:32:39'),
(1686, 31, 'anything_else_know', 'Yes', '2026-05-18 06:32:39', '2026-05-18 06:32:39'),
(1687, 31, 'anything_else_know_specify', 'NA', '2026-05-18 06:32:39', '2026-05-18 06:32:39'),
(1688, 31, 'other_disease', NULL, '2026-05-18 06:32:39', '2026-05-18 06:32:39'),
(1689, 31, 'anything_about_health', NULL, '2026-05-18 06:32:39', '2026-05-18 06:32:39'),
(1690, 31, 'anything_about_health_specify', NULL, '2026-05-18 06:32:39', '2026-05-18 06:32:39'),
(1691, 31, 'speak_doctor_privately', NULL, '2026-05-18 06:32:39', '2026-05-18 06:32:39'),
(1692, 31, 'date_last_complete_exam', NULL, '2026-05-18 06:32:39', '2026-05-18 06:32:39'),
(1693, 31, 'date_last_cleaning', NULL, '2026-05-18 06:32:39', '2026-05-18 06:32:39'),
(1694, 31, 'date_last_x_rays', NULL, '2026-05-18 06:32:39', '2026-05-18 06:32:39'),
(1695, 31, 'last_dentist_regularly', NULL, '2026-05-18 06:32:39', '2026-05-18 06:32:39'),
(1696, 31, 'last_dentist', NULL, '2026-05-18 06:32:39', '2026-05-18 06:32:39'),
(1697, 31, 'last_dentist_description', NULL, '2026-05-18 06:32:39', '2026-05-18 06:32:39'),
(1698, 31, 'antibiotics', NULL, '2026-05-18 06:32:39', '2026-05-18 06:32:39'),
(1699, 31, 'heavy_bleeding_extractions', NULL, '2026-05-18 06:32:39', '2026-05-18 06:32:39'),
(1700, 31, 'gum_treatment', NULL, '2026-05-18 06:32:39', '2026-05-18 06:32:39'),
(1701, 31, 'orthodontic_treatment', NULL, '2026-05-18 06:32:39', '2026-05-18 06:32:39'),
(1702, 31, 'unpleasant_dental_experience', NULL, '2026-05-18 06:32:39', '2026-05-18 06:32:39'),
(1703, 31, 'age', '22', '2026-05-18 06:32:39', '2026-05-18 06:32:39'),
(1704, 31, 'pleasant_dental_experience', NULL, '2026-05-18 06:32:39', '2026-05-18 06:32:39'),
(1705, 31, 'anything_else_should_know', NULL, '2026-05-18 06:32:39', '2026-05-18 06:32:39'),
(1706, 31, 'brings_office_today', NULL, '2026-05-18 06:32:39', '2026-05-18 06:32:39'),
(1707, 31, 'any_discomfort', NULL, '2026-05-18 06:32:39', '2026-05-18 06:32:39'),
(1708, 31, 'any_discomfort_specify', NULL, '2026-05-18 06:32:39', '2026-05-18 06:32:39'),
(1709, 31, 'have_experienced', 'Bad breath, Sore gums, Loose Teeth, Spaced or Crooked teeth, Lump or swelling in your mouth, Clench or Grind, Tuberculosis, Venereal Disease', '2026-05-18 06:32:39', '2026-05-18 06:32:39'),
(1710, 31, 'food_teeth', NULL, '2026-05-18 06:32:39', '2026-05-18 06:32:39'),
(1711, 31, 'sore_spots', NULL, '2026-05-18 06:32:39', '2026-05-18 06:32:39'),
(1712, 31, 'teeth_replaced', NULL, '2026-05-18 06:32:39', '2026-05-18 06:32:39'),
(1713, 31, 'permanent_tooth_replacement', NULL, '2026-05-18 06:32:39', '2026-05-18 06:32:39'),
(1714, 31, 'local_anesthesia', NULL, '2026-05-18 06:32:39', '2026-05-18 06:32:39'),
(1715, 31, 'general_anesthesia', NULL, '2026-05-18 06:32:39', '2026-05-18 06:32:39'),
(1716, 31, 'satisfied_appearance_teeth', NULL, '2026-05-18 06:32:39', '2026-05-18 06:32:39'),
(1717, 31, 'keep_natural_teeth', NULL, '2026-05-18 06:32:39', '2026-05-18 06:32:39'),
(1718, 31, 'tense_dental_visits', NULL, '2026-05-18 06:32:39', '2026-05-18 06:32:39'),
(1719, 31, 'calm_nerves', NULL, '2026-05-18 06:32:39', '2026-05-18 06:32:39'),
(1720, 31, 'describe', 'Just for testing purpose, please ignore it.', '2026-05-18 06:32:39', '2026-05-18 06:32:39'),
(1721, 31, 'signature', 'signature_31_1779100358.png', '2026-05-18 06:32:39', '2026-05-18 06:32:39'),
(1722, 31, 'print_name', 'Vikash Kumar', '2026-05-18 06:32:39', '2026-05-18 06:32:39'),
(1723, 31, 'location', 'Oakville', '2026-05-18 06:32:39', '2026-05-18 06:32:39'),
(1724, 31, 'consent_privacy_patient', 'Yes', '2026-05-18 06:32:39', '2026-05-18 06:32:39'),
(1725, 31, 'privacy_patient_name', 'Vikash Kumar', '2026-05-18 06:32:39', '2026-05-18 06:32:39'),
(1726, 31, 'consent_newsletter', NULL, '2026-05-18 06:32:39', '2026-05-18 06:32:39'),
(1727, 32, 'title', 'Mr.', '2026-05-18 06:36:57', '2026-05-18 06:36:57'),
(1728, 32, 'full_name', 'Vikash Kumar', '2026-05-18 06:36:57', '2026-05-18 06:36:57'),
(1729, 32, 'sex', 'Male', '2026-05-18 06:36:57', '2026-05-18 06:36:57'),
(1730, 32, 'marital_status', 'Married', '2026-05-18 06:36:57', '2026-05-18 06:36:57'),
(1731, 32, 'date_of_birth', '2026-05-01', '2026-05-18 06:36:57', '2026-05-18 06:36:57'),
(1732, 32, 'street_address', '1155 North Service Rd W Suite 11', '2026-05-18 06:36:57', '2026-05-18 06:36:57'),
(1733, 32, 'city', 'Oakville ON', '2026-05-18 06:36:57', '2026-05-18 06:36:57'),
(1734, 32, 'province', 'Oakville', '2026-05-18 06:36:57', '2026-05-18 06:36:57'),
(1735, 32, 'postal_code', 'L6M 3E3', '2026-05-18 06:36:57', '2026-05-18 06:36:57'),
(1736, 32, 'email_address', 'vikash@tastechnologies.com', '2026-05-18 06:36:57', '2026-05-18 06:36:57'),
(1737, 32, 'home_phone', NULL, '2026-05-18 06:36:57', '2026-05-18 06:36:57'),
(1738, 32, 'cell_phone', '416-578-0907', '2026-05-18 06:36:57', '2026-05-18 06:36:57'),
(1739, 32, 'cccupation', NULL, '2026-05-18 06:36:57', '2026-05-18 06:36:57'),
(1740, 32, 'employed_by', NULL, '2026-05-18 06:36:57', '2026-05-18 06:36:57'),
(1741, 32, 'dental_insurance', 'Yes', '2026-05-18 06:36:57', '2026-05-18 06:36:57'),
(1742, 32, 'insurance_company', NULL, '2026-05-18 06:36:57', '2026-05-18 06:36:57'),
(1743, 32, 'policy_no', NULL, '2026-05-18 06:36:57', '2026-05-18 06:36:57'),
(1744, 32, 'certificate_no', NULL, '2026-05-18 06:36:57', '2026-05-18 06:36:57'),
(1745, 32, 'family_physician', NULL, '2026-05-18 06:36:57', '2026-05-18 06:36:57'),
(1746, 32, 'physician_phone', NULL, '2026-05-18 06:36:57', '2026-05-18 06:36:57'),
(1747, 32, 'previous_dentist', NULL, '2026-05-18 06:36:57', '2026-05-18 06:36:57'),
(1748, 32, 'previous_dentist_phone', NULL, '2026-05-18 06:36:57', '2026-05-18 06:36:57'),
(1749, 32, 'referral_credit', NULL, '2026-05-18 06:36:57', '2026-05-18 06:36:57'),
(1750, 32, 'en_contact_name', NULL, '2026-05-18 06:36:57', '2026-05-18 06:36:57'),
(1751, 32, 'en_relationship', NULL, '2026-05-18 06:36:57', '2026-05-18 06:36:57'),
(1752, 32, 'en_address', NULL, '2026-05-18 06:36:57', '2026-05-18 06:36:57'),
(1753, 32, 'en_phone_number', NULL, '2026-05-18 06:36:57', '2026-05-18 06:36:57'),
(1754, 32, 'dlcp_examination', NULL, '2026-05-18 06:36:57', '2026-05-18 06:36:57'),
(1755, 32, 'cup_care', 'Yes', '2026-05-18 06:36:57', '2026-05-18 06:36:57'),
(1756, 32, 'cup_care_specify', 'NA', '2026-05-18 06:36:57', '2026-05-18 06:36:57'),
(1757, 32, 'frequent_headaches', NULL, '2026-05-18 06:36:57', '2026-05-18 06:36:57'),
(1758, 32, 'smoke', NULL, '2026-05-18 06:36:57', '2026-05-18 06:36:57'),
(1759, 32, 'drink_alcohol', NULL, '2026-05-18 06:36:57', '2026-05-18 06:36:57'),
(1760, 32, 'drink_alcohol_specify', NULL, '2026-05-18 06:36:57', '2026-05-18 06:36:57'),
(1761, 32, 'recreational_drugs', NULL, '2026-05-18 06:36:57', '2026-05-18 06:36:57'),
(1762, 32, 'herbal_substances', NULL, '2026-05-18 06:36:57', '2026-05-18 06:36:57'),
(1763, 32, 'herbal_substances_specify', NULL, '2026-05-18 06:36:57', '2026-05-18 06:36:57'),
(1764, 32, 'any_medications', NULL, '2026-05-18 06:36:57', '2026-05-18 06:36:57'),
(1765, 32, 'any_medications_specify', NULL, '2026-05-18 06:36:57', '2026-05-18 06:36:57'),
(1766, 32, 'prolonged_medication', NULL, '2026-05-18 06:36:57', '2026-05-18 06:36:57'),
(1767, 32, 'prolonged_medication_specify', NULL, '2026-05-18 06:36:57', '2026-05-18 06:36:57'),
(1768, 32, 'cortisone', NULL, '2026-05-18 06:36:57', '2026-05-18 06:36:57'),
(1769, 32, 'any_surgery', NULL, '2026-05-18 06:36:57', '2026-05-18 06:36:57'),
(1770, 32, 'any_surgery_specify', NULL, '2026-05-18 06:36:57', '2026-05-18 06:36:57'),
(1771, 32, 'ankles_swollen', NULL, '2026-05-18 06:36:57', '2026-05-18 06:36:57'),
(1772, 32, 'gained_lost_weight', NULL, '2026-05-18 06:36:57', '2026-05-18 06:36:57'),
(1773, 32, 'pregnant', 'Yes', '2026-05-18 06:36:57', '2026-05-18 06:36:57'),
(1774, 32, 'pregnant_weeks', '3 Months', '2026-05-18 06:36:57', '2026-05-18 06:36:57'),
(1775, 32, 'adverse_reaction', 'Penicillin, Metals, Sulfa Drugs', '2026-05-18 06:36:57', '2026-05-18 06:36:57'),
(1776, 32, 'allergic_adverse_reaction', 'Aspirin, Local Anesthetic (Freezing), Barbiturates (Sleeping pills), Codeine', '2026-05-18 06:36:57', '2026-05-18 06:36:57'),
(1777, 32, 'adverse_reactions', 'Yes', '2026-05-18 06:36:57', '2026-05-18 06:36:57'),
(1778, 32, 'adverse_reactions_specify', 'NA', '2026-05-18 06:36:57', '2026-05-18 06:36:57'),
(1779, 32, 'treated', 'Heart Murmur, HIV (AIDS), Liver Disease, Mental Disability, Renal Disease, Emphysema, Tuberculosis', '2026-05-18 06:36:57', '2026-05-18 06:36:57'),
(1780, 32, 'heavy_bleeding', NULL, '2026-05-18 06:36:57', '2026-05-18 06:36:57'),
(1781, 32, 'anything_else_know', NULL, '2026-05-18 06:36:57', '2026-05-18 06:36:57'),
(1782, 32, 'anything_else_know_specify', NULL, '2026-05-18 06:36:57', '2026-05-18 06:36:57'),
(1783, 32, 'other_disease', NULL, '2026-05-18 06:36:57', '2026-05-18 06:36:57'),
(1784, 32, 'anything_about_health', NULL, '2026-05-18 06:36:57', '2026-05-18 06:36:57'),
(1785, 32, 'anything_about_health_specify', NULL, '2026-05-18 06:36:57', '2026-05-18 06:36:57'),
(1786, 32, 'speak_doctor_privately', NULL, '2026-05-18 06:36:57', '2026-05-18 06:36:57'),
(1787, 32, 'date_last_complete_exam', NULL, '2026-05-18 06:36:57', '2026-05-18 06:36:57'),
(1788, 32, 'date_last_cleaning', NULL, '2026-05-18 06:36:57', '2026-05-18 06:36:57'),
(1789, 32, 'date_last_x_rays', NULL, '2026-05-18 06:36:57', '2026-05-18 06:36:57'),
(1790, 32, 'last_dentist_regularly', NULL, '2026-05-18 06:36:57', '2026-05-18 06:36:57'),
(1791, 32, 'last_dentist', NULL, '2026-05-18 06:36:57', '2026-05-18 06:36:57'),
(1792, 32, 'last_dentist_description', NULL, '2026-05-18 06:36:57', '2026-05-18 06:36:57'),
(1793, 32, 'antibiotics', NULL, '2026-05-18 06:36:57', '2026-05-18 06:36:57'),
(1794, 32, 'heavy_bleeding_extractions', NULL, '2026-05-18 06:36:57', '2026-05-18 06:36:57'),
(1795, 32, 'gum_treatment', NULL, '2026-05-18 06:36:57', '2026-05-18 06:36:57'),
(1796, 32, 'orthodontic_treatment', NULL, '2026-05-18 06:36:57', '2026-05-18 06:36:57'),
(1797, 32, 'unpleasant_dental_experience', NULL, '2026-05-18 06:36:57', '2026-05-18 06:36:57'),
(1798, 32, 'age', '22', '2026-05-18 06:36:57', '2026-05-18 06:36:57'),
(1799, 32, 'pleasant_dental_experience', NULL, '2026-05-18 06:36:57', '2026-05-18 06:36:57'),
(1800, 32, 'anything_else_should_know', NULL, '2026-05-18 06:36:57', '2026-05-18 06:36:57'),
(1801, 32, 'brings_office_today', NULL, '2026-05-18 06:36:57', '2026-05-18 06:36:57'),
(1802, 32, 'any_discomfort', NULL, '2026-05-18 06:36:57', '2026-05-18 06:36:57'),
(1803, 32, 'any_discomfort_specify', NULL, '2026-05-18 06:36:57', '2026-05-18 06:36:57'),
(1804, 32, 'have_experienced', 'Bad breath, Bleeding gums, Gagging, Difficulty opening or closing, Popping or clicking in the jaw joints', '2026-05-18 06:36:57', '2026-05-18 06:36:57'),
(1805, 32, 'food_teeth', NULL, '2026-05-18 06:36:57', '2026-05-18 06:36:57'),
(1806, 32, 'sore_spots', NULL, '2026-05-18 06:36:57', '2026-05-18 06:36:57'),
(1807, 32, 'teeth_replaced', NULL, '2026-05-18 06:36:57', '2026-05-18 06:36:57'),
(1808, 32, 'permanent_tooth_replacement', NULL, '2026-05-18 06:36:57', '2026-05-18 06:36:57'),
(1809, 32, 'local_anesthesia', NULL, '2026-05-18 06:36:57', '2026-05-18 06:36:57'),
(1810, 32, 'general_anesthesia', NULL, '2026-05-18 06:36:57', '2026-05-18 06:36:57'),
(1811, 32, 'satisfied_appearance_teeth', NULL, '2026-05-18 06:36:57', '2026-05-18 06:36:57'),
(1812, 32, 'keep_natural_teeth', NULL, '2026-05-18 06:36:57', '2026-05-18 06:36:57'),
(1813, 32, 'tense_dental_visits', NULL, '2026-05-18 06:36:57', '2026-05-18 06:36:57'),
(1814, 32, 'calm_nerves', NULL, '2026-05-18 06:36:57', '2026-05-18 06:36:57'),
(1815, 32, 'describe', 'Just for testing purpose, please ignore it.', '2026-05-18 06:36:57', '2026-05-18 06:36:57'),
(1816, 32, 'signature', 'signature_32_1779100617.png', '2026-05-18 06:36:57', '2026-05-18 06:36:57'),
(1817, 32, 'print_name', 'Vikash Kumar', '2026-05-18 06:36:57', '2026-05-18 06:36:57'),
(1818, 32, 'location', 'Mississauga', '2026-05-18 06:36:57', '2026-05-18 06:36:57'),
(1819, 32, 'consent_privacy_patient', 'Yes', '2026-05-18 06:36:57', '2026-05-18 06:36:57'),
(1820, 32, 'privacy_patient_name', 'Vikash Kumar', '2026-05-18 06:36:57', '2026-05-18 06:36:57'),
(1821, 32, 'consent_newsletter', NULL, '2026-05-18 06:36:57', '2026-05-18 06:36:57'),
(1822, 33, 'title', 'Mr.', '2026-05-18 06:56:33', '2026-05-18 06:56:33'),
(1823, 33, 'full_name', 'Vikash Kumar', '2026-05-18 06:56:33', '2026-05-18 06:56:33'),
(1824, 33, 'sex', 'Male', '2026-05-18 06:56:33', '2026-05-18 06:56:33'),
(1825, 33, 'marital_status', 'Married', '2026-05-18 06:56:33', '2026-05-18 06:56:33'),
(1826, 33, 'date_of_birth', '2026-05-07', '2026-05-18 06:56:33', '2026-05-18 06:56:33'),
(1827, 33, 'street_address', '1155 North Service Rd W Suite 11', '2026-05-18 06:56:33', '2026-05-18 06:56:33'),
(1828, 33, 'city', 'Oakville ON', '2026-05-18 06:56:33', '2026-05-18 06:56:33'),
(1829, 33, 'province', 'Oakville', '2026-05-18 06:56:33', '2026-05-18 06:56:33'),
(1830, 33, 'postal_code', 'L6M 3E3', '2026-05-18 06:56:33', '2026-05-18 06:56:33'),
(1831, 33, 'email_address', 'vikashfsdev@gmail.com', '2026-05-18 06:56:33', '2026-05-18 06:56:33'),
(1832, 33, 'home_phone', NULL, '2026-05-18 06:56:33', '2026-05-18 06:56:33'),
(1833, 33, 'cell_phone', '416-578-0907', '2026-05-18 06:56:33', '2026-05-18 06:56:33'),
(1834, 33, 'cccupation', NULL, '2026-05-18 06:56:33', '2026-05-18 06:56:33'),
(1835, 33, 'employed_by', NULL, '2026-05-18 06:56:33', '2026-05-18 06:56:33'),
(1836, 33, 'dental_insurance', NULL, '2026-05-18 06:56:33', '2026-05-18 06:56:33'),
(1837, 33, 'insurance_company', NULL, '2026-05-18 06:56:33', '2026-05-18 06:56:33'),
(1838, 33, 'policy_no', NULL, '2026-05-18 06:56:33', '2026-05-18 06:56:33'),
(1839, 33, 'certificate_no', NULL, '2026-05-18 06:56:33', '2026-05-18 06:56:33'),
(1840, 33, 'family_physician', NULL, '2026-05-18 06:56:33', '2026-05-18 06:56:33'),
(1841, 33, 'physician_phone', NULL, '2026-05-18 06:56:33', '2026-05-18 06:56:33'),
(1842, 33, 'previous_dentist', NULL, '2026-05-18 06:56:33', '2026-05-18 06:56:33'),
(1843, 33, 'previous_dentist_phone', NULL, '2026-05-18 06:56:33', '2026-05-18 06:56:33'),
(1844, 33, 'referral_credit', NULL, '2026-05-18 06:56:33', '2026-05-18 06:56:33'),
(1845, 33, 'en_contact_name', NULL, '2026-05-18 06:56:33', '2026-05-18 06:56:33'),
(1846, 33, 'en_relationship', NULL, '2026-05-18 06:56:33', '2026-05-18 06:56:33'),
(1847, 33, 'en_address', NULL, '2026-05-18 06:56:33', '2026-05-18 06:56:33'),
(1848, 33, 'en_phone_number', NULL, '2026-05-18 06:56:33', '2026-05-18 06:56:33'),
(1849, 33, 'dlcp_examination', NULL, '2026-05-18 06:56:33', '2026-05-18 06:56:33'),
(1850, 33, 'cup_care', NULL, '2026-05-18 06:56:33', '2026-05-18 06:56:33'),
(1851, 33, 'cup_care_specify', NULL, '2026-05-18 06:56:33', '2026-05-18 06:56:33'),
(1852, 33, 'frequent_headaches', NULL, '2026-05-18 06:56:33', '2026-05-18 06:56:33'),
(1853, 33, 'smoke', NULL, '2026-05-18 06:56:33', '2026-05-18 06:56:33'),
(1854, 33, 'drink_alcohol', NULL, '2026-05-18 06:56:33', '2026-05-18 06:56:33'),
(1855, 33, 'drink_alcohol_specify', NULL, '2026-05-18 06:56:33', '2026-05-18 06:56:33'),
(1856, 33, 'recreational_drugs', NULL, '2026-05-18 06:56:33', '2026-05-18 06:56:33'),
(1857, 33, 'herbal_substances', NULL, '2026-05-18 06:56:33', '2026-05-18 06:56:33'),
(1858, 33, 'herbal_substances_specify', NULL, '2026-05-18 06:56:33', '2026-05-18 06:56:33'),
(1859, 33, 'any_medications', NULL, '2026-05-18 06:56:33', '2026-05-18 06:56:33'),
(1860, 33, 'any_medications_specify', NULL, '2026-05-18 06:56:33', '2026-05-18 06:56:33'),
(1861, 33, 'prolonged_medication', NULL, '2026-05-18 06:56:33', '2026-05-18 06:56:33'),
(1862, 33, 'prolonged_medication_specify', NULL, '2026-05-18 06:56:33', '2026-05-18 06:56:33'),
(1863, 33, 'cortisone', NULL, '2026-05-18 06:56:33', '2026-05-18 06:56:33'),
(1864, 33, 'any_surgery', NULL, '2026-05-18 06:56:33', '2026-05-18 06:56:33'),
(1865, 33, 'any_surgery_specify', NULL, '2026-05-18 06:56:33', '2026-05-18 06:56:33'),
(1866, 33, 'ankles_swollen', NULL, '2026-05-18 06:56:33', '2026-05-18 06:56:33'),
(1867, 33, 'gained_lost_weight', NULL, '2026-05-18 06:56:33', '2026-05-18 06:56:33'),
(1868, 33, 'pregnant', NULL, '2026-05-18 06:56:33', '2026-05-18 06:56:33'),
(1869, 33, 'pregnant_weeks', NULL, '2026-05-18 06:56:33', '2026-05-18 06:56:33'),
(1870, 33, 'adverse_reaction', 'Latex, Penicillin, Sulfa Drugs', '2026-05-18 06:56:33', '2026-05-18 06:56:33'),
(1871, 33, 'allergic_adverse_reaction', 'Local Anesthetic (Freezing), Barbiturates (Sleeping pills), Nitrous Oxide, Codeine', '2026-05-18 06:56:33', '2026-05-18 06:56:33'),
(1872, 33, 'adverse_reactions', 'Yes', '2026-05-18 06:56:33', '2026-05-18 06:56:33'),
(1873, 33, 'adverse_reactions_specify', 'NA', '2026-05-18 06:56:33', '2026-05-18 06:56:33'),
(1874, 33, 'treated', 'Heart Murmur, HIV (AIDS), Hypertension / Low BP, Anemia, Liver Disease, Rheumatic Fever, Diabetes Type I / Type II, Thyroid Disease', '2026-05-18 06:56:33', '2026-05-18 06:56:33'),
(1875, 33, 'heavy_bleeding', NULL, '2026-05-18 06:56:33', '2026-05-18 06:56:33'),
(1876, 33, 'anything_else_know', 'Yes', '2026-05-18 06:56:33', '2026-05-18 06:56:33'),
(1877, 33, 'anything_else_know_specify', 'NA', '2026-05-18 06:56:33', '2026-05-18 06:56:33'),
(1878, 33, 'other_disease', NULL, '2026-05-18 06:56:33', '2026-05-18 06:56:33'),
(1879, 33, 'anything_about_health', NULL, '2026-05-18 06:56:33', '2026-05-18 06:56:33'),
(1880, 33, 'anything_about_health_specify', NULL, '2026-05-18 06:56:33', '2026-05-18 06:56:33'),
(1881, 33, 'speak_doctor_privately', NULL, '2026-05-18 06:56:33', '2026-05-18 06:56:33'),
(1882, 33, 'date_last_complete_exam', NULL, '2026-05-18 06:56:33', '2026-05-18 06:56:33'),
(1883, 33, 'date_last_cleaning', NULL, '2026-05-18 06:56:33', '2026-05-18 06:56:33'),
(1884, 33, 'date_last_x_rays', NULL, '2026-05-18 06:56:33', '2026-05-18 06:56:33'),
(1885, 33, 'last_dentist_regularly', NULL, '2026-05-18 06:56:33', '2026-05-18 06:56:33'),
(1886, 33, 'last_dentist', NULL, '2026-05-18 06:56:33', '2026-05-18 06:56:33'),
(1887, 33, 'last_dentist_description', NULL, '2026-05-18 06:56:33', '2026-05-18 06:56:33'),
(1888, 33, 'antibiotics', NULL, '2026-05-18 06:56:33', '2026-05-18 06:56:33'),
(1889, 33, 'heavy_bleeding_extractions', NULL, '2026-05-18 06:56:33', '2026-05-18 06:56:33'),
(1890, 33, 'gum_treatment', NULL, '2026-05-18 06:56:33', '2026-05-18 06:56:33'),
(1891, 33, 'orthodontic_treatment', NULL, '2026-05-18 06:56:33', '2026-05-18 06:56:33'),
(1892, 33, 'unpleasant_dental_experience', NULL, '2026-05-18 06:56:33', '2026-05-18 06:56:33'),
(1893, 33, 'age', '22', '2026-05-18 06:56:33', '2026-05-18 06:56:33'),
(1894, 33, 'pleasant_dental_experience', NULL, '2026-05-18 06:56:33', '2026-05-18 06:56:33'),
(1895, 33, 'anything_else_should_know', NULL, '2026-05-18 06:56:33', '2026-05-18 06:56:33'),
(1896, 33, 'brings_office_today', NULL, '2026-05-18 06:56:33', '2026-05-18 06:56:33'),
(1897, 33, 'any_discomfort', NULL, '2026-05-18 06:56:33', '2026-05-18 06:56:33'),
(1898, 33, 'any_discomfort_specify', NULL, '2026-05-18 06:56:33', '2026-05-18 06:56:33'),
(1899, 33, 'have_experienced', 'Bad breath, Gagging, Spaced or Crooked teeth, Unsatisfactory dentures, Clench or Grind, Emphysema, Tuberculosis', '2026-05-18 06:56:33', '2026-05-18 06:56:33'),
(1900, 33, 'food_teeth', NULL, '2026-05-18 06:56:33', '2026-05-18 06:56:33'),
(1901, 33, 'sore_spots', NULL, '2026-05-18 06:56:33', '2026-05-18 06:56:33'),
(1902, 33, 'teeth_replaced', NULL, '2026-05-18 06:56:33', '2026-05-18 06:56:33'),
(1903, 33, 'permanent_tooth_replacement', NULL, '2026-05-18 06:56:33', '2026-05-18 06:56:33'),
(1904, 33, 'local_anesthesia', NULL, '2026-05-18 06:56:33', '2026-05-18 06:56:33'),
(1905, 33, 'general_anesthesia', NULL, '2026-05-18 06:56:33', '2026-05-18 06:56:33'),
(1906, 33, 'satisfied_appearance_teeth', NULL, '2026-05-18 06:56:33', '2026-05-18 06:56:33'),
(1907, 33, 'keep_natural_teeth', NULL, '2026-05-18 06:56:33', '2026-05-18 06:56:33'),
(1908, 33, 'tense_dental_visits', NULL, '2026-05-18 06:56:33', '2026-05-18 06:56:33'),
(1909, 33, 'calm_nerves', NULL, '2026-05-18 06:56:33', '2026-05-18 06:56:33'),
(1910, 33, 'describe', 'Just for testing purpose, please ignore it.', '2026-05-18 06:56:33', '2026-05-18 06:56:33'),
(1911, 33, 'signature', 'signature_33_1779101793.png', '2026-05-18 06:56:33', '2026-05-18 06:56:33'),
(1912, 33, 'print_name', 'Vikash Kumar', '2026-05-18 06:56:33', '2026-05-18 06:56:33'),
(1913, 33, 'location', 'Burlington', '2026-05-18 06:56:33', '2026-05-18 06:56:33'),
(1914, 33, 'consent_privacy_patient', 'Yes', '2026-05-18 06:56:33', '2026-05-18 06:56:33'),
(1915, 33, 'privacy_patient_name', 'Vikash Kumar', '2026-05-18 06:56:33', '2026-05-18 06:56:33'),
(1916, 33, 'consent_newsletter', NULL, '2026-05-18 06:56:33', '2026-05-18 06:56:33'),
(1917, 34, 'title', 'Mr.', '2026-05-18 07:16:19', '2026-05-18 07:16:19'),
(1918, 34, 'full_name', 'Vikash Kumar', '2026-05-18 07:16:19', '2026-05-18 07:16:19'),
(1919, 34, 'sex', 'Male', '2026-05-18 07:16:19', '2026-05-18 07:16:19'),
(1920, 34, 'marital_status', 'Married', '2026-05-18 07:16:19', '2026-05-18 07:16:19'),
(1921, 34, 'date_of_birth', '2026-05-07', '2026-05-18 07:16:19', '2026-05-18 07:16:19'),
(1922, 34, 'street_address', '1155 North Service Rd W Suite 11', '2026-05-18 07:16:19', '2026-05-18 07:16:19'),
(1923, 34, 'city', 'Oakville ON', '2026-05-18 07:16:19', '2026-05-18 07:16:19'),
(1924, 34, 'province', 'Oakville', '2026-05-18 07:16:19', '2026-05-18 07:16:19'),
(1925, 34, 'postal_code', 'L6M 3E3', '2026-05-18 07:16:19', '2026-05-18 07:16:19'),
(1926, 34, 'email_address', 'vikash@tastechnologies.com', '2026-05-18 07:16:19', '2026-05-18 07:16:19'),
(1927, 34, 'home_phone', NULL, '2026-05-18 07:16:19', '2026-05-18 07:16:19'),
(1928, 34, 'cell_phone', '416-578-0907', '2026-05-18 07:16:19', '2026-05-18 07:16:19'),
(1929, 34, 'cccupation', NULL, '2026-05-18 07:16:19', '2026-05-18 07:16:19'),
(1930, 34, 'employed_by', NULL, '2026-05-18 07:16:19', '2026-05-18 07:16:19'),
(1931, 34, 'dental_insurance', 'Yes', '2026-05-18 07:16:19', '2026-05-18 07:16:19'),
(1932, 34, 'insurance_company', NULL, '2026-05-18 07:16:19', '2026-05-18 07:16:19'),
(1933, 34, 'policy_no', NULL, '2026-05-18 07:16:19', '2026-05-18 07:16:19'),
(1934, 34, 'certificate_no', NULL, '2026-05-18 07:16:19', '2026-05-18 07:16:19'),
(1935, 34, 'family_physician', NULL, '2026-05-18 07:16:19', '2026-05-18 07:16:19'),
(1936, 34, 'physician_phone', NULL, '2026-05-18 07:16:19', '2026-05-18 07:16:19'),
(1937, 34, 'previous_dentist', NULL, '2026-05-18 07:16:19', '2026-05-18 07:16:19'),
(1938, 34, 'previous_dentist_phone', NULL, '2026-05-18 07:16:19', '2026-05-18 07:16:19'),
(1939, 34, 'referral_credit', NULL, '2026-05-18 07:16:19', '2026-05-18 07:16:19'),
(1940, 34, 'en_contact_name', NULL, '2026-05-18 07:16:19', '2026-05-18 07:16:19'),
(1941, 34, 'en_relationship', NULL, '2026-05-18 07:16:19', '2026-05-18 07:16:19'),
(1942, 34, 'en_address', NULL, '2026-05-18 07:16:19', '2026-05-18 07:16:19'),
(1943, 34, 'en_phone_number', NULL, '2026-05-18 07:16:19', '2026-05-18 07:16:19'),
(1944, 34, 'dlcp_examination', NULL, '2026-05-18 07:16:19', '2026-05-18 07:16:19'),
(1945, 34, 'cup_care', NULL, '2026-05-18 07:16:19', '2026-05-18 07:16:19'),
(1946, 34, 'cup_care_specify', NULL, '2026-05-18 07:16:19', '2026-05-18 07:16:19'),
(1947, 34, 'frequent_headaches', NULL, '2026-05-18 07:16:19', '2026-05-18 07:16:19'),
(1948, 34, 'smoke', NULL, '2026-05-18 07:16:19', '2026-05-18 07:16:19'),
(1949, 34, 'drink_alcohol', NULL, '2026-05-18 07:16:19', '2026-05-18 07:16:19'),
(1950, 34, 'drink_alcohol_specify', NULL, '2026-05-18 07:16:19', '2026-05-18 07:16:19'),
(1951, 34, 'recreational_drugs', NULL, '2026-05-18 07:16:19', '2026-05-18 07:16:19'),
(1952, 34, 'herbal_substances', NULL, '2026-05-18 07:16:19', '2026-05-18 07:16:19'),
(1953, 34, 'herbal_substances_specify', NULL, '2026-05-18 07:16:19', '2026-05-18 07:16:19'),
(1954, 34, 'any_medications', NULL, '2026-05-18 07:16:19', '2026-05-18 07:16:19'),
(1955, 34, 'any_medications_specify', NULL, '2026-05-18 07:16:19', '2026-05-18 07:16:19'),
(1956, 34, 'prolonged_medication', NULL, '2026-05-18 07:16:19', '2026-05-18 07:16:19'),
(1957, 34, 'prolonged_medication_specify', NULL, '2026-05-18 07:16:19', '2026-05-18 07:16:19'),
(1958, 34, 'cortisone', NULL, '2026-05-18 07:16:19', '2026-05-18 07:16:19'),
(1959, 34, 'any_surgery', NULL, '2026-05-18 07:16:19', '2026-05-18 07:16:19'),
(1960, 34, 'any_surgery_specify', NULL, '2026-05-18 07:16:19', '2026-05-18 07:16:19'),
(1961, 34, 'ankles_swollen', NULL, '2026-05-18 07:16:19', '2026-05-18 07:16:19'),
(1962, 34, 'gained_lost_weight', NULL, '2026-05-18 07:16:19', '2026-05-18 07:16:19'),
(1963, 34, 'pregnant', NULL, '2026-05-18 07:16:19', '2026-05-18 07:16:19'),
(1964, 34, 'pregnant_weeks', NULL, '2026-05-18 07:16:19', '2026-05-18 07:16:19'),
(1965, 34, 'adverse_reaction', 'Latex, Penicillin, Metals', '2026-05-18 07:16:19', '2026-05-18 07:16:19'),
(1966, 34, 'allergic_adverse_reaction', 'Aspirin, Local Anesthetic (Freezing), Barbiturates (Sleeping pills), Codeine', '2026-05-18 07:16:19', '2026-05-18 07:16:19'),
(1967, 34, 'adverse_reactions', NULL, '2026-05-18 07:16:19', '2026-05-18 07:16:19'),
(1968, 34, 'adverse_reactions_specify', NULL, '2026-05-18 07:16:19', '2026-05-18 07:16:19'),
(1969, 34, 'treated', 'Heart Murmur, HIV (AIDS), Blood Disorder, Liver Disease, Leukemia, Mental Disability, Diabetes Type I / Type II, Thyroid Disease, Emphysema, Tuberculosis', '2026-05-18 07:16:19', '2026-05-18 07:16:19'),
(1970, 34, 'heavy_bleeding', NULL, '2026-05-18 07:16:19', '2026-05-18 07:16:19'),
(1971, 34, 'anything_else_know', NULL, '2026-05-18 07:16:19', '2026-05-18 07:16:19'),
(1972, 34, 'anything_else_know_specify', NULL, '2026-05-18 07:16:19', '2026-05-18 07:16:19'),
(1973, 34, 'other_disease', NULL, '2026-05-18 07:16:19', '2026-05-18 07:16:19'),
(1974, 34, 'anything_about_health', NULL, '2026-05-18 07:16:19', '2026-05-18 07:16:19'),
(1975, 34, 'anything_about_health_specify', NULL, '2026-05-18 07:16:19', '2026-05-18 07:16:19'),
(1976, 34, 'speak_doctor_privately', NULL, '2026-05-18 07:16:19', '2026-05-18 07:16:19'),
(1977, 34, 'date_last_complete_exam', NULL, '2026-05-18 07:16:19', '2026-05-18 07:16:19'),
(1978, 34, 'date_last_cleaning', NULL, '2026-05-18 07:16:19', '2026-05-18 07:16:19'),
(1979, 34, 'date_last_x_rays', NULL, '2026-05-18 07:16:19', '2026-05-18 07:16:19'),
(1980, 34, 'last_dentist_regularly', NULL, '2026-05-18 07:16:19', '2026-05-18 07:16:19'),
(1981, 34, 'last_dentist', NULL, '2026-05-18 07:16:19', '2026-05-18 07:16:19'),
(1982, 34, 'last_dentist_description', NULL, '2026-05-18 07:16:19', '2026-05-18 07:16:19'),
(1983, 34, 'antibiotics', NULL, '2026-05-18 07:16:19', '2026-05-18 07:16:19'),
(1984, 34, 'heavy_bleeding_extractions', NULL, '2026-05-18 07:16:19', '2026-05-18 07:16:19'),
(1985, 34, 'gum_treatment', NULL, '2026-05-18 07:16:19', '2026-05-18 07:16:19'),
(1986, 34, 'orthodontic_treatment', NULL, '2026-05-18 07:16:19', '2026-05-18 07:16:19'),
(1987, 34, 'unpleasant_dental_experience', NULL, '2026-05-18 07:16:19', '2026-05-18 07:16:19'),
(1988, 34, 'age', '22', '2026-05-18 07:16:19', '2026-05-18 07:16:19'),
(1989, 34, 'pleasant_dental_experience', NULL, '2026-05-18 07:16:19', '2026-05-18 07:16:19'),
(1990, 34, 'anything_else_should_know', NULL, '2026-05-18 07:16:19', '2026-05-18 07:16:19');
INSERT INTO `cdt_form_submission_values` (`id`, `submission_id`, `field_name`, `field_value`, `created_at`, `updated_at`) VALUES
(1991, 34, 'brings_office_today', NULL, '2026-05-18 07:16:19', '2026-05-18 07:16:19'),
(1992, 34, 'any_discomfort', NULL, '2026-05-18 07:16:19', '2026-05-18 07:16:19'),
(1993, 34, 'any_discomfort_specify', NULL, '2026-05-18 07:16:19', '2026-05-18 07:16:19'),
(1994, 34, 'have_experienced', 'Tooth sensitivity, Bad breath, Ear ache, Missing teeth, Spaced or Crooked teeth, Lump or swelling in your mouth, Clench or Grind, Emphysema, Tuberculosis, Epilepsy', '2026-05-18 07:16:19', '2026-05-18 07:16:19'),
(1995, 34, 'food_teeth', NULL, '2026-05-18 07:16:19', '2026-05-18 07:16:19'),
(1996, 34, 'sore_spots', NULL, '2026-05-18 07:16:19', '2026-05-18 07:16:19'),
(1997, 34, 'teeth_replaced', NULL, '2026-05-18 07:16:19', '2026-05-18 07:16:19'),
(1998, 34, 'permanent_tooth_replacement', NULL, '2026-05-18 07:16:19', '2026-05-18 07:16:19'),
(1999, 34, 'local_anesthesia', NULL, '2026-05-18 07:16:19', '2026-05-18 07:16:19'),
(2000, 34, 'general_anesthesia', NULL, '2026-05-18 07:16:19', '2026-05-18 07:16:19'),
(2001, 34, 'satisfied_appearance_teeth', NULL, '2026-05-18 07:16:19', '2026-05-18 07:16:19'),
(2002, 34, 'keep_natural_teeth', NULL, '2026-05-18 07:16:19', '2026-05-18 07:16:19'),
(2003, 34, 'tense_dental_visits', NULL, '2026-05-18 07:16:19', '2026-05-18 07:16:19'),
(2004, 34, 'calm_nerves', NULL, '2026-05-18 07:16:19', '2026-05-18 07:16:19'),
(2005, 34, 'describe', 'Just for testing purpose, please ignore it.', '2026-05-18 07:16:19', '2026-05-18 07:16:19'),
(2006, 34, 'signature', 'signature_34_1779102979.png', '2026-05-18 07:16:19', '2026-05-18 07:16:19'),
(2007, 34, 'print_name', 'Vikash Kumar', '2026-05-18 07:16:20', '2026-05-18 07:16:20'),
(2008, 34, 'location', 'Burlington', '2026-05-18 07:16:20', '2026-05-18 07:16:20'),
(2009, 34, 'consent_privacy_patient', 'Yes', '2026-05-18 07:16:20', '2026-05-18 07:16:20'),
(2010, 34, 'privacy_patient_name', 'Vikash Kumar', '2026-05-18 07:16:20', '2026-05-18 07:16:20'),
(2011, 34, 'consent_newsletter', NULL, '2026-05-18 07:16:20', '2026-05-18 07:16:20'),
(2012, 35, 'title', 'Mr.', '2026-05-18 07:40:00', '2026-05-18 07:40:00'),
(2013, 35, 'full_name', 'Vikash Kumar', '2026-05-18 07:40:00', '2026-05-18 07:40:00'),
(2014, 35, 'sex', 'Male', '2026-05-18 07:40:00', '2026-05-18 07:40:00'),
(2015, 35, 'marital_status', 'Married', '2026-05-18 07:40:00', '2026-05-18 07:40:00'),
(2016, 35, 'date_of_birth', '2026-05-08', '2026-05-18 07:40:00', '2026-05-18 07:40:00'),
(2017, 35, 'street_address', '1155 North Service Rd W Suite 11', '2026-05-18 07:40:00', '2026-05-18 07:40:00'),
(2018, 35, 'city', 'Oakville ON', '2026-05-18 07:40:00', '2026-05-18 07:40:00'),
(2019, 35, 'province', 'Oakville', '2026-05-18 07:40:00', '2026-05-18 07:40:00'),
(2020, 35, 'postal_code', 'L6M 3E3', '2026-05-18 07:40:00', '2026-05-18 07:40:00'),
(2021, 35, 'email_address', 'vikash@tastechnologies.com', '2026-05-18 07:40:00', '2026-05-18 07:40:00'),
(2022, 35, 'home_phone', NULL, '2026-05-18 07:40:00', '2026-05-18 07:40:00'),
(2023, 35, 'cell_phone', '416-578-0907', '2026-05-18 07:40:00', '2026-05-18 07:40:00'),
(2024, 35, 'cccupation', NULL, '2026-05-18 07:40:00', '2026-05-18 07:40:00'),
(2025, 35, 'employed_by', NULL, '2026-05-18 07:40:00', '2026-05-18 07:40:00'),
(2026, 35, 'dental_insurance', 'Yes', '2026-05-18 07:40:00', '2026-05-18 07:40:00'),
(2027, 35, 'insurance_company', NULL, '2026-05-18 07:40:00', '2026-05-18 07:40:00'),
(2028, 35, 'policy_no', NULL, '2026-05-18 07:40:00', '2026-05-18 07:40:00'),
(2029, 35, 'certificate_no', NULL, '2026-05-18 07:40:00', '2026-05-18 07:40:00'),
(2030, 35, 'family_physician', NULL, '2026-05-18 07:40:00', '2026-05-18 07:40:00'),
(2031, 35, 'physician_phone', NULL, '2026-05-18 07:40:00', '2026-05-18 07:40:00'),
(2032, 35, 'previous_dentist', NULL, '2026-05-18 07:40:00', '2026-05-18 07:40:00'),
(2033, 35, 'previous_dentist_phone', NULL, '2026-05-18 07:40:00', '2026-05-18 07:40:00'),
(2034, 35, 'referral_credit', NULL, '2026-05-18 07:40:00', '2026-05-18 07:40:00'),
(2035, 35, 'en_contact_name', NULL, '2026-05-18 07:40:00', '2026-05-18 07:40:00'),
(2036, 35, 'en_relationship', NULL, '2026-05-18 07:40:00', '2026-05-18 07:40:00'),
(2037, 35, 'en_address', NULL, '2026-05-18 07:40:00', '2026-05-18 07:40:00'),
(2038, 35, 'en_phone_number', NULL, '2026-05-18 07:40:00', '2026-05-18 07:40:00'),
(2039, 35, 'dlcp_examination', NULL, '2026-05-18 07:40:00', '2026-05-18 07:40:00'),
(2040, 35, 'cup_care', NULL, '2026-05-18 07:40:00', '2026-05-18 07:40:00'),
(2041, 35, 'cup_care_specify', NULL, '2026-05-18 07:40:00', '2026-05-18 07:40:00'),
(2042, 35, 'frequent_headaches', NULL, '2026-05-18 07:40:00', '2026-05-18 07:40:00'),
(2043, 35, 'smoke', NULL, '2026-05-18 07:40:00', '2026-05-18 07:40:00'),
(2044, 35, 'drink_alcohol', NULL, '2026-05-18 07:40:00', '2026-05-18 07:40:00'),
(2045, 35, 'drink_alcohol_specify', NULL, '2026-05-18 07:40:00', '2026-05-18 07:40:00'),
(2046, 35, 'recreational_drugs', NULL, '2026-05-18 07:40:00', '2026-05-18 07:40:00'),
(2047, 35, 'herbal_substances', NULL, '2026-05-18 07:40:00', '2026-05-18 07:40:00'),
(2048, 35, 'herbal_substances_specify', NULL, '2026-05-18 07:40:00', '2026-05-18 07:40:00'),
(2049, 35, 'any_medications', NULL, '2026-05-18 07:40:00', '2026-05-18 07:40:00'),
(2050, 35, 'any_medications_specify', NULL, '2026-05-18 07:40:00', '2026-05-18 07:40:00'),
(2051, 35, 'prolonged_medication', NULL, '2026-05-18 07:40:00', '2026-05-18 07:40:00'),
(2052, 35, 'prolonged_medication_specify', NULL, '2026-05-18 07:40:00', '2026-05-18 07:40:00'),
(2053, 35, 'cortisone', NULL, '2026-05-18 07:40:00', '2026-05-18 07:40:00'),
(2054, 35, 'any_surgery', NULL, '2026-05-18 07:40:00', '2026-05-18 07:40:00'),
(2055, 35, 'any_surgery_specify', NULL, '2026-05-18 07:40:00', '2026-05-18 07:40:00'),
(2056, 35, 'ankles_swollen', NULL, '2026-05-18 07:40:00', '2026-05-18 07:40:00'),
(2057, 35, 'gained_lost_weight', NULL, '2026-05-18 07:40:00', '2026-05-18 07:40:00'),
(2058, 35, 'pregnant', NULL, '2026-05-18 07:40:00', '2026-05-18 07:40:00'),
(2059, 35, 'pregnant_weeks', NULL, '2026-05-18 07:40:00', '2026-05-18 07:40:00'),
(2060, 35, 'adverse_reaction', 'Penicillin, Metals, Sulfa Drugs', '2026-05-18 07:40:00', '2026-05-18 07:40:00'),
(2061, 35, 'allergic_adverse_reaction', 'Aspirin, Local Anesthetic (Freezing), Nitrous Oxide', '2026-05-18 07:40:00', '2026-05-18 07:40:00'),
(2062, 35, 'adverse_reactions', NULL, '2026-05-18 07:40:00', '2026-05-18 07:40:00'),
(2063, 35, 'adverse_reactions_specify', NULL, '2026-05-18 07:40:00', '2026-05-18 07:40:00'),
(2064, 35, 'treated', 'Heart Murmur, Arthritis, Hepatitis B, HIV (AIDS), Hypertension / Low BP, Liver Disease, Renal Disease, Cancer, Rheumatic Fever, Tuberculosis, Epilepsy, Venereal Disease', '2026-05-18 07:40:00', '2026-05-18 07:40:00'),
(2065, 35, 'heavy_bleeding', NULL, '2026-05-18 07:40:00', '2026-05-18 07:40:00'),
(2066, 35, 'anything_else_know', NULL, '2026-05-18 07:40:00', '2026-05-18 07:40:00'),
(2067, 35, 'anything_else_know_specify', NULL, '2026-05-18 07:40:00', '2026-05-18 07:40:00'),
(2068, 35, 'other_disease', NULL, '2026-05-18 07:40:00', '2026-05-18 07:40:00'),
(2069, 35, 'anything_about_health', NULL, '2026-05-18 07:40:00', '2026-05-18 07:40:00'),
(2070, 35, 'anything_about_health_specify', NULL, '2026-05-18 07:40:00', '2026-05-18 07:40:00'),
(2071, 35, 'speak_doctor_privately', NULL, '2026-05-18 07:40:00', '2026-05-18 07:40:00'),
(2072, 35, 'date_last_complete_exam', NULL, '2026-05-18 07:40:00', '2026-05-18 07:40:00'),
(2073, 35, 'date_last_cleaning', NULL, '2026-05-18 07:40:00', '2026-05-18 07:40:00'),
(2074, 35, 'date_last_x_rays', NULL, '2026-05-18 07:40:00', '2026-05-18 07:40:00'),
(2075, 35, 'last_dentist_regularly', NULL, '2026-05-18 07:40:00', '2026-05-18 07:40:00'),
(2076, 35, 'last_dentist', NULL, '2026-05-18 07:40:00', '2026-05-18 07:40:00'),
(2077, 35, 'last_dentist_description', NULL, '2026-05-18 07:40:00', '2026-05-18 07:40:00'),
(2078, 35, 'antibiotics', NULL, '2026-05-18 07:40:00', '2026-05-18 07:40:00'),
(2079, 35, 'heavy_bleeding_extractions', NULL, '2026-05-18 07:40:00', '2026-05-18 07:40:00'),
(2080, 35, 'gum_treatment', NULL, '2026-05-18 07:40:00', '2026-05-18 07:40:00'),
(2081, 35, 'orthodontic_treatment', NULL, '2026-05-18 07:40:00', '2026-05-18 07:40:00'),
(2082, 35, 'unpleasant_dental_experience', NULL, '2026-05-18 07:40:00', '2026-05-18 07:40:00'),
(2083, 35, 'age', '22', '2026-05-18 07:40:00', '2026-05-18 07:40:00'),
(2084, 35, 'pleasant_dental_experience', NULL, '2026-05-18 07:40:00', '2026-05-18 07:40:00'),
(2085, 35, 'anything_else_should_know', NULL, '2026-05-18 07:40:00', '2026-05-18 07:40:00'),
(2086, 35, 'brings_office_today', NULL, '2026-05-18 07:40:00', '2026-05-18 07:40:00'),
(2087, 35, 'any_discomfort', NULL, '2026-05-18 07:40:00', '2026-05-18 07:40:00'),
(2088, 35, 'any_discomfort_specify', NULL, '2026-05-18 07:40:00', '2026-05-18 07:40:00'),
(2089, 35, 'have_experienced', 'Tooth sensitivity, Bad breath, Sore gums, Gagging, Missing teeth, Unsatisfactory dentures, Neck pain, Popping or clicking in the jaw joints, Tuberculosis, Epilepsy, Venereal Disease', '2026-05-18 07:40:00', '2026-05-18 07:40:00'),
(2090, 35, 'food_teeth', NULL, '2026-05-18 07:40:00', '2026-05-18 07:40:00'),
(2091, 35, 'sore_spots', NULL, '2026-05-18 07:40:00', '2026-05-18 07:40:00'),
(2092, 35, 'teeth_replaced', NULL, '2026-05-18 07:40:00', '2026-05-18 07:40:00'),
(2093, 35, 'permanent_tooth_replacement', NULL, '2026-05-18 07:40:00', '2026-05-18 07:40:00'),
(2094, 35, 'local_anesthesia', NULL, '2026-05-18 07:40:00', '2026-05-18 07:40:00'),
(2095, 35, 'general_anesthesia', NULL, '2026-05-18 07:40:00', '2026-05-18 07:40:00'),
(2096, 35, 'satisfied_appearance_teeth', NULL, '2026-05-18 07:40:00', '2026-05-18 07:40:00'),
(2097, 35, 'keep_natural_teeth', NULL, '2026-05-18 07:40:00', '2026-05-18 07:40:00'),
(2098, 35, 'tense_dental_visits', NULL, '2026-05-18 07:40:00', '2026-05-18 07:40:00'),
(2099, 35, 'calm_nerves', NULL, '2026-05-18 07:40:00', '2026-05-18 07:40:00'),
(2100, 35, 'describe', 'Just for testing purpose, please ignore it.', '2026-05-18 07:40:00', '2026-05-18 07:40:00'),
(2101, 35, 'signature', 'signature_35_1779104400.png', '2026-05-18 07:40:00', '2026-05-18 07:40:00'),
(2102, 35, 'print_name', 'Vikash Kumar', '2026-05-18 07:40:00', '2026-05-18 07:40:00'),
(2103, 35, 'location', 'Oakville', '2026-05-18 07:40:00', '2026-05-18 07:40:00'),
(2104, 35, 'consent_privacy_patient', 'Yes', '2026-05-18 07:40:00', '2026-05-18 07:40:00'),
(2105, 35, 'privacy_patient_name', 'Vikash Kumar', '2026-05-18 07:40:00', '2026-05-18 07:40:00'),
(2106, 35, 'consent_newsletter', NULL, '2026-05-18 07:40:00', '2026-05-18 07:40:00'),
(2107, 36, 'title', 'Mr.', '2026-05-18 07:53:35', '2026-05-18 07:53:35'),
(2108, 36, 'full_name', 'Vikash Kumar', '2026-05-18 07:53:35', '2026-05-18 07:53:35'),
(2109, 36, 'sex', 'Female', '2026-05-18 07:53:35', '2026-05-18 07:53:35'),
(2110, 36, 'marital_status', 'Prefer Not to Say', '2026-05-18 07:53:35', '2026-05-18 07:53:35'),
(2111, 36, 'date_of_birth', '2026-05-07', '2026-05-18 07:53:35', '2026-05-18 07:53:35'),
(2112, 36, 'street_address', '1155 North Service Rd W Suite 11', '2026-05-18 07:53:35', '2026-05-18 07:53:35'),
(2113, 36, 'city', 'Oakville ON', '2026-05-18 07:53:35', '2026-05-18 07:53:35'),
(2114, 36, 'province', 'Oakville', '2026-05-18 07:53:35', '2026-05-18 07:53:35'),
(2115, 36, 'postal_code', 'L6M 3E3', '2026-05-18 07:53:35', '2026-05-18 07:53:35'),
(2116, 36, 'email_address', 'vikash@tastechnologies.com', '2026-05-18 07:53:35', '2026-05-18 07:53:35'),
(2117, 36, 'home_phone', NULL, '2026-05-18 07:53:35', '2026-05-18 07:53:35'),
(2118, 36, 'cell_phone', '416-578-0907', '2026-05-18 07:53:35', '2026-05-18 07:53:35'),
(2119, 36, 'cccupation', NULL, '2026-05-18 07:53:35', '2026-05-18 07:53:35'),
(2120, 36, 'employed_by', NULL, '2026-05-18 07:53:35', '2026-05-18 07:53:35'),
(2121, 36, 'dental_insurance', NULL, '2026-05-18 07:53:35', '2026-05-18 07:53:35'),
(2122, 36, 'insurance_company', NULL, '2026-05-18 07:53:35', '2026-05-18 07:53:35'),
(2123, 36, 'policy_no', NULL, '2026-05-18 07:53:35', '2026-05-18 07:53:35'),
(2124, 36, 'certificate_no', NULL, '2026-05-18 07:53:35', '2026-05-18 07:53:35'),
(2125, 36, 'family_physician', NULL, '2026-05-18 07:53:35', '2026-05-18 07:53:35'),
(2126, 36, 'physician_phone', NULL, '2026-05-18 07:53:35', '2026-05-18 07:53:35'),
(2127, 36, 'previous_dentist', NULL, '2026-05-18 07:53:35', '2026-05-18 07:53:35'),
(2128, 36, 'previous_dentist_phone', NULL, '2026-05-18 07:53:35', '2026-05-18 07:53:35'),
(2129, 36, 'referral_credit', NULL, '2026-05-18 07:53:35', '2026-05-18 07:53:35'),
(2130, 36, 'en_contact_name', NULL, '2026-05-18 07:53:35', '2026-05-18 07:53:35'),
(2131, 36, 'en_relationship', NULL, '2026-05-18 07:53:35', '2026-05-18 07:53:35'),
(2132, 36, 'en_address', NULL, '2026-05-18 07:53:35', '2026-05-18 07:53:35'),
(2133, 36, 'en_phone_number', NULL, '2026-05-18 07:53:35', '2026-05-18 07:53:35'),
(2134, 36, 'dlcp_examination', NULL, '2026-05-18 07:53:35', '2026-05-18 07:53:35'),
(2135, 36, 'cup_care', NULL, '2026-05-18 07:53:35', '2026-05-18 07:53:35'),
(2136, 36, 'cup_care_specify', NULL, '2026-05-18 07:53:35', '2026-05-18 07:53:35'),
(2137, 36, 'frequent_headaches', NULL, '2026-05-18 07:53:35', '2026-05-18 07:53:35'),
(2138, 36, 'smoke', NULL, '2026-05-18 07:53:35', '2026-05-18 07:53:35'),
(2139, 36, 'drink_alcohol', NULL, '2026-05-18 07:53:35', '2026-05-18 07:53:35'),
(2140, 36, 'drink_alcohol_specify', NULL, '2026-05-18 07:53:35', '2026-05-18 07:53:35'),
(2141, 36, 'recreational_drugs', NULL, '2026-05-18 07:53:35', '2026-05-18 07:53:35'),
(2142, 36, 'herbal_substances', NULL, '2026-05-18 07:53:35', '2026-05-18 07:53:35'),
(2143, 36, 'herbal_substances_specify', NULL, '2026-05-18 07:53:35', '2026-05-18 07:53:35'),
(2144, 36, 'any_medications', NULL, '2026-05-18 07:53:35', '2026-05-18 07:53:35'),
(2145, 36, 'any_medications_specify', NULL, '2026-05-18 07:53:35', '2026-05-18 07:53:35'),
(2146, 36, 'prolonged_medication', NULL, '2026-05-18 07:53:35', '2026-05-18 07:53:35'),
(2147, 36, 'prolonged_medication_specify', NULL, '2026-05-18 07:53:35', '2026-05-18 07:53:35'),
(2148, 36, 'cortisone', NULL, '2026-05-18 07:53:35', '2026-05-18 07:53:35'),
(2149, 36, 'any_surgery', NULL, '2026-05-18 07:53:35', '2026-05-18 07:53:35'),
(2150, 36, 'any_surgery_specify', NULL, '2026-05-18 07:53:35', '2026-05-18 07:53:35'),
(2151, 36, 'ankles_swollen', NULL, '2026-05-18 07:53:35', '2026-05-18 07:53:35'),
(2152, 36, 'gained_lost_weight', NULL, '2026-05-18 07:53:35', '2026-05-18 07:53:35'),
(2153, 36, 'pregnant', NULL, '2026-05-18 07:53:35', '2026-05-18 07:53:35'),
(2154, 36, 'pregnant_weeks', NULL, '2026-05-18 07:53:35', '2026-05-18 07:53:35'),
(2155, 36, 'adverse_reaction', 'Latex, Penicillin', '2026-05-18 07:53:35', '2026-05-18 07:53:35'),
(2156, 36, 'allergic_adverse_reaction', 'Local Anesthetic (Freezing), Codeine', '2026-05-18 07:53:35', '2026-05-18 07:53:35'),
(2157, 36, 'adverse_reactions', NULL, '2026-05-18 07:53:35', '2026-05-18 07:53:35'),
(2158, 36, 'adverse_reactions_specify', NULL, '2026-05-18 07:53:35', '2026-05-18 07:53:35'),
(2159, 36, 'treated', 'Heart Murmur, Blood Disorder, Hypertension / Low BP, Cardiovascular Disease, Venereal Disease', '2026-05-18 07:53:35', '2026-05-18 07:53:35'),
(2160, 36, 'heavy_bleeding', NULL, '2026-05-18 07:53:35', '2026-05-18 07:53:35'),
(2161, 36, 'anything_else_know', NULL, '2026-05-18 07:53:35', '2026-05-18 07:53:35'),
(2162, 36, 'anything_else_know_specify', NULL, '2026-05-18 07:53:35', '2026-05-18 07:53:35'),
(2163, 36, 'other_disease', NULL, '2026-05-18 07:53:35', '2026-05-18 07:53:35'),
(2164, 36, 'anything_about_health', NULL, '2026-05-18 07:53:35', '2026-05-18 07:53:35'),
(2165, 36, 'anything_about_health_specify', NULL, '2026-05-18 07:53:35', '2026-05-18 07:53:35'),
(2166, 36, 'speak_doctor_privately', NULL, '2026-05-18 07:53:35', '2026-05-18 07:53:35'),
(2167, 36, 'date_last_complete_exam', NULL, '2026-05-18 07:53:35', '2026-05-18 07:53:35'),
(2168, 36, 'date_last_cleaning', NULL, '2026-05-18 07:53:35', '2026-05-18 07:53:35'),
(2169, 36, 'date_last_x_rays', NULL, '2026-05-18 07:53:35', '2026-05-18 07:53:35'),
(2170, 36, 'last_dentist_regularly', NULL, '2026-05-18 07:53:35', '2026-05-18 07:53:35'),
(2171, 36, 'last_dentist', NULL, '2026-05-18 07:53:35', '2026-05-18 07:53:35'),
(2172, 36, 'last_dentist_description', NULL, '2026-05-18 07:53:35', '2026-05-18 07:53:35'),
(2173, 36, 'antibiotics', NULL, '2026-05-18 07:53:35', '2026-05-18 07:53:35'),
(2174, 36, 'heavy_bleeding_extractions', NULL, '2026-05-18 07:53:35', '2026-05-18 07:53:35'),
(2175, 36, 'gum_treatment', NULL, '2026-05-18 07:53:35', '2026-05-18 07:53:35'),
(2176, 36, 'orthodontic_treatment', NULL, '2026-05-18 07:53:35', '2026-05-18 07:53:35'),
(2177, 36, 'unpleasant_dental_experience', NULL, '2026-05-18 07:53:35', '2026-05-18 07:53:35'),
(2178, 36, 'age', '22', '2026-05-18 07:53:35', '2026-05-18 07:53:35'),
(2179, 36, 'pleasant_dental_experience', NULL, '2026-05-18 07:53:35', '2026-05-18 07:53:35'),
(2180, 36, 'anything_else_should_know', NULL, '2026-05-18 07:53:35', '2026-05-18 07:53:35'),
(2181, 36, 'brings_office_today', NULL, '2026-05-18 07:53:35', '2026-05-18 07:53:35'),
(2182, 36, 'any_discomfort', NULL, '2026-05-18 07:53:35', '2026-05-18 07:53:35'),
(2183, 36, 'any_discomfort_specify', NULL, '2026-05-18 07:53:35', '2026-05-18 07:53:35'),
(2184, 36, 'have_experienced', 'Headaches, Sore gums, Unsatisfactory dentures, Lump or swelling in your mouth, Emphysema', '2026-05-18 07:53:35', '2026-05-18 07:53:35'),
(2185, 36, 'food_teeth', NULL, '2026-05-18 07:53:35', '2026-05-18 07:53:35'),
(2186, 36, 'sore_spots', NULL, '2026-05-18 07:53:35', '2026-05-18 07:53:35'),
(2187, 36, 'teeth_replaced', NULL, '2026-05-18 07:53:35', '2026-05-18 07:53:35'),
(2188, 36, 'permanent_tooth_replacement', NULL, '2026-05-18 07:53:35', '2026-05-18 07:53:35'),
(2189, 36, 'local_anesthesia', NULL, '2026-05-18 07:53:35', '2026-05-18 07:53:35'),
(2190, 36, 'general_anesthesia', NULL, '2026-05-18 07:53:35', '2026-05-18 07:53:35'),
(2191, 36, 'satisfied_appearance_teeth', NULL, '2026-05-18 07:53:35', '2026-05-18 07:53:35'),
(2192, 36, 'keep_natural_teeth', NULL, '2026-05-18 07:53:35', '2026-05-18 07:53:35'),
(2193, 36, 'tense_dental_visits', NULL, '2026-05-18 07:53:35', '2026-05-18 07:53:35'),
(2194, 36, 'calm_nerves', NULL, '2026-05-18 07:53:35', '2026-05-18 07:53:35'),
(2195, 36, 'describe', 'Just for testing purpose, please ignore it.', '2026-05-18 07:53:35', '2026-05-18 07:53:35'),
(2196, 36, 'signature', 'signature_36_1779105214.png', '2026-05-18 07:53:35', '2026-05-18 07:53:35'),
(2197, 36, 'print_name', 'Vikash Kumar', '2026-05-18 07:53:35', '2026-05-18 07:53:35'),
(2198, 36, 'location', 'Mississauga', '2026-05-18 07:53:35', '2026-05-18 07:53:35'),
(2199, 36, 'consent_privacy_patient', 'Yes', '2026-05-18 07:53:35', '2026-05-18 07:53:35'),
(2200, 36, 'privacy_patient_name', 'Vikash Kumar', '2026-05-18 07:53:35', '2026-05-18 07:53:35'),
(2201, 36, 'consent_newsletter', 'Yes', '2026-05-18 07:53:35', '2026-05-18 07:53:35'),
(2202, 37, 'title', 'Mr.', '2026-05-18 08:10:03', '2026-05-18 08:10:03'),
(2203, 37, 'full_name', 'Vikash Kumar', '2026-05-18 08:10:03', '2026-05-18 08:10:03'),
(2204, 37, 'sex', 'Male', '2026-05-18 08:10:03', '2026-05-18 08:10:03'),
(2205, 37, 'marital_status', 'Married', '2026-05-18 08:10:03', '2026-05-18 08:10:03'),
(2206, 37, 'date_of_birth', '2026-05-05', '2026-05-18 08:10:03', '2026-05-18 08:10:03'),
(2207, 37, 'street_address', '1155 North Service Rd W Suite 11', '2026-05-18 08:10:03', '2026-05-18 08:10:03'),
(2208, 37, 'city', 'Oakville ON', '2026-05-18 08:10:03', '2026-05-18 08:10:03'),
(2209, 37, 'province', 'Oakville', '2026-05-18 08:10:03', '2026-05-18 08:10:03'),
(2210, 37, 'postal_code', 'L6M 3E3', '2026-05-18 08:10:03', '2026-05-18 08:10:03'),
(2211, 37, 'email_address', 'vikash@tastechnologies.com', '2026-05-18 08:10:03', '2026-05-18 08:10:03'),
(2212, 37, 'home_phone', NULL, '2026-05-18 08:10:03', '2026-05-18 08:10:03'),
(2213, 37, 'cell_phone', '416-578-0907', '2026-05-18 08:10:03', '2026-05-18 08:10:03'),
(2214, 37, 'cccupation', NULL, '2026-05-18 08:10:03', '2026-05-18 08:10:03'),
(2215, 37, 'employed_by', NULL, '2026-05-18 08:10:03', '2026-05-18 08:10:03'),
(2216, 37, 'dental_insurance', 'Yes', '2026-05-18 08:10:03', '2026-05-18 08:10:03'),
(2217, 37, 'insurance_company', NULL, '2026-05-18 08:10:03', '2026-05-18 08:10:03'),
(2218, 37, 'policy_no', NULL, '2026-05-18 08:10:03', '2026-05-18 08:10:03'),
(2219, 37, 'certificate_no', NULL, '2026-05-18 08:10:03', '2026-05-18 08:10:03'),
(2220, 37, 'family_physician', NULL, '2026-05-18 08:10:03', '2026-05-18 08:10:03'),
(2221, 37, 'physician_phone', NULL, '2026-05-18 08:10:03', '2026-05-18 08:10:03'),
(2222, 37, 'previous_dentist', NULL, '2026-05-18 08:10:03', '2026-05-18 08:10:03'),
(2223, 37, 'previous_dentist_phone', NULL, '2026-05-18 08:10:03', '2026-05-18 08:10:03'),
(2224, 37, 'referral_credit', NULL, '2026-05-18 08:10:04', '2026-05-18 08:10:04'),
(2225, 37, 'en_contact_name', NULL, '2026-05-18 08:10:04', '2026-05-18 08:10:04'),
(2226, 37, 'en_relationship', NULL, '2026-05-18 08:10:04', '2026-05-18 08:10:04'),
(2227, 37, 'en_address', NULL, '2026-05-18 08:10:04', '2026-05-18 08:10:04'),
(2228, 37, 'en_phone_number', NULL, '2026-05-18 08:10:04', '2026-05-18 08:10:04'),
(2229, 37, 'dlcp_examination', NULL, '2026-05-18 08:10:04', '2026-05-18 08:10:04'),
(2230, 37, 'cup_care', NULL, '2026-05-18 08:10:04', '2026-05-18 08:10:04'),
(2231, 37, 'cup_care_specify', NULL, '2026-05-18 08:10:04', '2026-05-18 08:10:04'),
(2232, 37, 'frequent_headaches', NULL, '2026-05-18 08:10:04', '2026-05-18 08:10:04'),
(2233, 37, 'smoke', NULL, '2026-05-18 08:10:04', '2026-05-18 08:10:04'),
(2234, 37, 'drink_alcohol', NULL, '2026-05-18 08:10:04', '2026-05-18 08:10:04'),
(2235, 37, 'drink_alcohol_specify', NULL, '2026-05-18 08:10:04', '2026-05-18 08:10:04'),
(2236, 37, 'recreational_drugs', NULL, '2026-05-18 08:10:04', '2026-05-18 08:10:04'),
(2237, 37, 'herbal_substances', NULL, '2026-05-18 08:10:04', '2026-05-18 08:10:04'),
(2238, 37, 'herbal_substances_specify', NULL, '2026-05-18 08:10:04', '2026-05-18 08:10:04'),
(2239, 37, 'any_medications', NULL, '2026-05-18 08:10:04', '2026-05-18 08:10:04'),
(2240, 37, 'any_medications_specify', NULL, '2026-05-18 08:10:04', '2026-05-18 08:10:04'),
(2241, 37, 'prolonged_medication', NULL, '2026-05-18 08:10:04', '2026-05-18 08:10:04'),
(2242, 37, 'prolonged_medication_specify', NULL, '2026-05-18 08:10:04', '2026-05-18 08:10:04'),
(2243, 37, 'cortisone', NULL, '2026-05-18 08:10:04', '2026-05-18 08:10:04'),
(2244, 37, 'any_surgery', NULL, '2026-05-18 08:10:04', '2026-05-18 08:10:04'),
(2245, 37, 'any_surgery_specify', NULL, '2026-05-18 08:10:04', '2026-05-18 08:10:04'),
(2246, 37, 'ankles_swollen', NULL, '2026-05-18 08:10:04', '2026-05-18 08:10:04'),
(2247, 37, 'gained_lost_weight', NULL, '2026-05-18 08:10:04', '2026-05-18 08:10:04'),
(2248, 37, 'pregnant', NULL, '2026-05-18 08:10:04', '2026-05-18 08:10:04'),
(2249, 37, 'pregnant_weeks', NULL, '2026-05-18 08:10:04', '2026-05-18 08:10:04'),
(2250, 37, 'adverse_reaction', NULL, '2026-05-18 08:10:04', '2026-05-18 08:10:04'),
(2251, 37, 'allergic_adverse_reaction', NULL, '2026-05-18 08:10:04', '2026-05-18 08:10:04'),
(2252, 37, 'adverse_reactions', NULL, '2026-05-18 08:10:04', '2026-05-18 08:10:04'),
(2253, 37, 'adverse_reactions_specify', NULL, '2026-05-18 08:10:04', '2026-05-18 08:10:04'),
(2254, 37, 'treated', NULL, '2026-05-18 08:10:04', '2026-05-18 08:10:04'),
(2255, 37, 'heavy_bleeding', NULL, '2026-05-18 08:10:04', '2026-05-18 08:10:04'),
(2256, 37, 'anything_else_know', NULL, '2026-05-18 08:10:04', '2026-05-18 08:10:04'),
(2257, 37, 'anything_else_know_specify', NULL, '2026-05-18 08:10:04', '2026-05-18 08:10:04'),
(2258, 37, 'other_disease', NULL, '2026-05-18 08:10:04', '2026-05-18 08:10:04'),
(2259, 37, 'anything_about_health', NULL, '2026-05-18 08:10:04', '2026-05-18 08:10:04'),
(2260, 37, 'anything_about_health_specify', NULL, '2026-05-18 08:10:04', '2026-05-18 08:10:04'),
(2261, 37, 'speak_doctor_privately', NULL, '2026-05-18 08:10:04', '2026-05-18 08:10:04'),
(2262, 37, 'date_last_complete_exam', NULL, '2026-05-18 08:10:04', '2026-05-18 08:10:04'),
(2263, 37, 'date_last_cleaning', NULL, '2026-05-18 08:10:04', '2026-05-18 08:10:04'),
(2264, 37, 'date_last_x_rays', NULL, '2026-05-18 08:10:04', '2026-05-18 08:10:04'),
(2265, 37, 'last_dentist_regularly', NULL, '2026-05-18 08:10:04', '2026-05-18 08:10:04'),
(2266, 37, 'last_dentist', NULL, '2026-05-18 08:10:04', '2026-05-18 08:10:04'),
(2267, 37, 'last_dentist_description', NULL, '2026-05-18 08:10:04', '2026-05-18 08:10:04'),
(2268, 37, 'antibiotics', NULL, '2026-05-18 08:10:04', '2026-05-18 08:10:04'),
(2269, 37, 'heavy_bleeding_extractions', NULL, '2026-05-18 08:10:04', '2026-05-18 08:10:04'),
(2270, 37, 'gum_treatment', NULL, '2026-05-18 08:10:04', '2026-05-18 08:10:04'),
(2271, 37, 'orthodontic_treatment', NULL, '2026-05-18 08:10:04', '2026-05-18 08:10:04'),
(2272, 37, 'unpleasant_dental_experience', NULL, '2026-05-18 08:10:04', '2026-05-18 08:10:04'),
(2273, 37, 'age', '22', '2026-05-18 08:10:04', '2026-05-18 08:10:04'),
(2274, 37, 'pleasant_dental_experience', NULL, '2026-05-18 08:10:04', '2026-05-18 08:10:04'),
(2275, 37, 'anything_else_should_know', NULL, '2026-05-18 08:10:04', '2026-05-18 08:10:04'),
(2276, 37, 'brings_office_today', NULL, '2026-05-18 08:10:04', '2026-05-18 08:10:04'),
(2277, 37, 'any_discomfort', NULL, '2026-05-18 08:10:04', '2026-05-18 08:10:04'),
(2278, 37, 'any_discomfort_specify', NULL, '2026-05-18 08:10:04', '2026-05-18 08:10:04'),
(2279, 37, 'have_experienced', NULL, '2026-05-18 08:10:04', '2026-05-18 08:10:04'),
(2280, 37, 'food_teeth', NULL, '2026-05-18 08:10:04', '2026-05-18 08:10:04'),
(2281, 37, 'sore_spots', NULL, '2026-05-18 08:10:04', '2026-05-18 08:10:04'),
(2282, 37, 'teeth_replaced', NULL, '2026-05-18 08:10:04', '2026-05-18 08:10:04'),
(2283, 37, 'permanent_tooth_replacement', NULL, '2026-05-18 08:10:04', '2026-05-18 08:10:04'),
(2284, 37, 'local_anesthesia', NULL, '2026-05-18 08:10:04', '2026-05-18 08:10:04'),
(2285, 37, 'general_anesthesia', NULL, '2026-05-18 08:10:04', '2026-05-18 08:10:04'),
(2286, 37, 'satisfied_appearance_teeth', NULL, '2026-05-18 08:10:04', '2026-05-18 08:10:04'),
(2287, 37, 'keep_natural_teeth', NULL, '2026-05-18 08:10:04', '2026-05-18 08:10:04'),
(2288, 37, 'tense_dental_visits', NULL, '2026-05-18 08:10:04', '2026-05-18 08:10:04'),
(2289, 37, 'calm_nerves', NULL, '2026-05-18 08:10:04', '2026-05-18 08:10:04'),
(2290, 37, 'describe', 'assa ssa', '2026-05-18 08:10:04', '2026-05-18 08:10:04'),
(2291, 37, 'signature', 'signature_37_1779106203.png', '2026-05-18 08:10:04', '2026-05-18 08:10:04'),
(2292, 37, 'print_name', 'Vikash Kumar', '2026-05-18 08:10:04', '2026-05-18 08:10:04'),
(2293, 37, 'location', 'Burlington', '2026-05-18 08:10:04', '2026-05-18 08:10:04'),
(2294, 37, 'consent_privacy_patient', 'Yes', '2026-05-18 08:10:04', '2026-05-18 08:10:04'),
(2295, 37, 'privacy_patient_name', 'Vikash Kumar', '2026-05-18 08:10:04', '2026-05-18 08:10:04'),
(2296, 37, 'consent_newsletter', NULL, '2026-05-18 08:10:04', '2026-05-18 08:10:04'),
(2297, 38, 'title', 'Mr.', '2026-05-18 08:18:11', '2026-05-18 08:18:11'),
(2298, 38, 'full_name', 'Vikash Kumar', '2026-05-18 08:18:11', '2026-05-18 08:18:11'),
(2299, 38, 'sex', 'Male', '2026-05-18 08:18:11', '2026-05-18 08:18:11'),
(2300, 38, 'marital_status', 'Married', '2026-05-18 08:18:11', '2026-05-18 08:18:11'),
(2301, 38, 'date_of_birth', '2026-05-06', '2026-05-18 08:18:11', '2026-05-18 08:18:11'),
(2302, 38, 'street_address', '1155 North Service Rd W Suite 11', '2026-05-18 08:18:11', '2026-05-18 08:18:11'),
(2303, 38, 'city', 'Oakville ON', '2026-05-18 08:18:11', '2026-05-18 08:18:11'),
(2304, 38, 'province', 'Oakville', '2026-05-18 08:18:11', '2026-05-18 08:18:11'),
(2305, 38, 'postal_code', 'L6M 3E3', '2026-05-18 08:18:11', '2026-05-18 08:18:11'),
(2306, 38, 'email_address', 'vikash@tastechnologies.com', '2026-05-18 08:18:11', '2026-05-18 08:18:11'),
(2307, 38, 'home_phone', NULL, '2026-05-18 08:18:11', '2026-05-18 08:18:11'),
(2308, 38, 'cell_phone', '416-578-0907', '2026-05-18 08:18:12', '2026-05-18 08:18:12'),
(2309, 38, 'cccupation', NULL, '2026-05-18 08:18:12', '2026-05-18 08:18:12'),
(2310, 38, 'employed_by', NULL, '2026-05-18 08:18:12', '2026-05-18 08:18:12'),
(2311, 38, 'dental_insurance', 'Yes', '2026-05-18 08:18:12', '2026-05-18 08:18:12'),
(2312, 38, 'insurance_company', NULL, '2026-05-18 08:18:12', '2026-05-18 08:18:12'),
(2313, 38, 'policy_no', NULL, '2026-05-18 08:18:12', '2026-05-18 08:18:12'),
(2314, 38, 'certificate_no', NULL, '2026-05-18 08:18:12', '2026-05-18 08:18:12'),
(2315, 38, 'family_physician', NULL, '2026-05-18 08:18:12', '2026-05-18 08:18:12'),
(2316, 38, 'physician_phone', NULL, '2026-05-18 08:18:12', '2026-05-18 08:18:12'),
(2317, 38, 'previous_dentist', NULL, '2026-05-18 08:18:12', '2026-05-18 08:18:12'),
(2318, 38, 'previous_dentist_phone', NULL, '2026-05-18 08:18:12', '2026-05-18 08:18:12'),
(2319, 38, 'referral_credit', NULL, '2026-05-18 08:18:12', '2026-05-18 08:18:12'),
(2320, 38, 'en_contact_name', NULL, '2026-05-18 08:18:12', '2026-05-18 08:18:12'),
(2321, 38, 'en_relationship', NULL, '2026-05-18 08:18:12', '2026-05-18 08:18:12'),
(2322, 38, 'en_address', NULL, '2026-05-18 08:18:12', '2026-05-18 08:18:12'),
(2323, 38, 'en_phone_number', NULL, '2026-05-18 08:18:12', '2026-05-18 08:18:12'),
(2324, 38, 'dlcp_examination', NULL, '2026-05-18 08:18:12', '2026-05-18 08:18:12'),
(2325, 38, 'cup_care', NULL, '2026-05-18 08:18:12', '2026-05-18 08:18:12'),
(2326, 38, 'cup_care_specify', NULL, '2026-05-18 08:18:12', '2026-05-18 08:18:12'),
(2327, 38, 'frequent_headaches', NULL, '2026-05-18 08:18:12', '2026-05-18 08:18:12'),
(2328, 38, 'smoke', NULL, '2026-05-18 08:18:12', '2026-05-18 08:18:12'),
(2329, 38, 'drink_alcohol', NULL, '2026-05-18 08:18:12', '2026-05-18 08:18:12'),
(2330, 38, 'drink_alcohol_specify', NULL, '2026-05-18 08:18:12', '2026-05-18 08:18:12'),
(2331, 38, 'recreational_drugs', NULL, '2026-05-18 08:18:12', '2026-05-18 08:18:12'),
(2332, 38, 'herbal_substances', NULL, '2026-05-18 08:18:12', '2026-05-18 08:18:12'),
(2333, 38, 'herbal_substances_specify', NULL, '2026-05-18 08:18:12', '2026-05-18 08:18:12'),
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(2522, 40, 'herbal_substances', NULL, '2026-05-18 09:02:05', '2026-05-18 09:02:05'),
(2523, 40, 'herbal_substances_specify', NULL, '2026-05-18 09:02:05', '2026-05-18 09:02:05'),
(2524, 40, 'any_medications', NULL, '2026-05-18 09:02:05', '2026-05-18 09:02:05'),
(2525, 40, 'any_medications_specify', NULL, '2026-05-18 09:02:05', '2026-05-18 09:02:05'),
(2526, 40, 'prolonged_medication', NULL, '2026-05-18 09:02:05', '2026-05-18 09:02:05'),
(2527, 40, 'prolonged_medication_specify', NULL, '2026-05-18 09:02:05', '2026-05-18 09:02:05'),
(2528, 40, 'cortisone', NULL, '2026-05-18 09:02:05', '2026-05-18 09:02:05'),
(2529, 40, 'any_surgery', NULL, '2026-05-18 09:02:05', '2026-05-18 09:02:05'),
(2530, 40, 'any_surgery_specify', NULL, '2026-05-18 09:02:05', '2026-05-18 09:02:05'),
(2531, 40, 'ankles_swollen', NULL, '2026-05-18 09:02:05', '2026-05-18 09:02:05'),
(2532, 40, 'gained_lost_weight', NULL, '2026-05-18 09:02:05', '2026-05-18 09:02:05'),
(2533, 40, 'pregnant', NULL, '2026-05-18 09:02:05', '2026-05-18 09:02:05'),
(2534, 40, 'pregnant_weeks', NULL, '2026-05-18 09:02:05', '2026-05-18 09:02:05'),
(2535, 40, 'adverse_reaction', NULL, '2026-05-18 09:02:05', '2026-05-18 09:02:05'),
(2536, 40, 'allergic_adverse_reaction', NULL, '2026-05-18 09:02:05', '2026-05-18 09:02:05'),
(2537, 40, 'adverse_reactions', NULL, '2026-05-18 09:02:05', '2026-05-18 09:02:05'),
(2538, 40, 'adverse_reactions_specify', NULL, '2026-05-18 09:02:05', '2026-05-18 09:02:05'),
(2539, 40, 'treated', NULL, '2026-05-18 09:02:05', '2026-05-18 09:02:05'),
(2540, 40, 'heavy_bleeding', NULL, '2026-05-18 09:02:05', '2026-05-18 09:02:05'),
(2541, 40, 'anything_else_know', NULL, '2026-05-18 09:02:05', '2026-05-18 09:02:05'),
(2542, 40, 'anything_else_know_specify', NULL, '2026-05-18 09:02:05', '2026-05-18 09:02:05'),
(2543, 40, 'other_disease', NULL, '2026-05-18 09:02:05', '2026-05-18 09:02:05'),
(2544, 40, 'anything_about_health', NULL, '2026-05-18 09:02:05', '2026-05-18 09:02:05'),
(2545, 40, 'anything_about_health_specify', NULL, '2026-05-18 09:02:05', '2026-05-18 09:02:05'),
(2546, 40, 'speak_doctor_privately', NULL, '2026-05-18 09:02:05', '2026-05-18 09:02:05'),
(2547, 40, 'date_last_complete_exam', NULL, '2026-05-18 09:02:05', '2026-05-18 09:02:05'),
(2548, 40, 'date_last_cleaning', NULL, '2026-05-18 09:02:05', '2026-05-18 09:02:05'),
(2549, 40, 'date_last_x_rays', NULL, '2026-05-18 09:02:05', '2026-05-18 09:02:05'),
(2550, 40, 'last_dentist_regularly', NULL, '2026-05-18 09:02:05', '2026-05-18 09:02:05'),
(2551, 40, 'last_dentist', NULL, '2026-05-18 09:02:05', '2026-05-18 09:02:05'),
(2552, 40, 'last_dentist_description', NULL, '2026-05-18 09:02:05', '2026-05-18 09:02:05'),
(2553, 40, 'antibiotics', NULL, '2026-05-18 09:02:05', '2026-05-18 09:02:05'),
(2554, 40, 'heavy_bleeding_extractions', NULL, '2026-05-18 09:02:05', '2026-05-18 09:02:05'),
(2555, 40, 'gum_treatment', NULL, '2026-05-18 09:02:05', '2026-05-18 09:02:05'),
(2556, 40, 'orthodontic_treatment', NULL, '2026-05-18 09:02:05', '2026-05-18 09:02:05'),
(2557, 40, 'unpleasant_dental_experience', NULL, '2026-05-18 09:02:05', '2026-05-18 09:02:05'),
(2558, 40, 'age', '22', '2026-05-18 09:02:05', '2026-05-18 09:02:05'),
(2559, 40, 'pleasant_dental_experience', NULL, '2026-05-18 09:02:05', '2026-05-18 09:02:05'),
(2560, 40, 'anything_else_should_know', NULL, '2026-05-18 09:02:05', '2026-05-18 09:02:05'),
(2561, 40, 'brings_office_today', NULL, '2026-05-18 09:02:05', '2026-05-18 09:02:05'),
(2562, 40, 'any_discomfort', NULL, '2026-05-18 09:02:05', '2026-05-18 09:02:05'),
(2563, 40, 'any_discomfort_specify', NULL, '2026-05-18 09:02:05', '2026-05-18 09:02:05'),
(2564, 40, 'have_experienced', NULL, '2026-05-18 09:02:06', '2026-05-18 09:02:06'),
(2565, 40, 'food_teeth', NULL, '2026-05-18 09:02:06', '2026-05-18 09:02:06'),
(2566, 40, 'sore_spots', NULL, '2026-05-18 09:02:06', '2026-05-18 09:02:06'),
(2567, 40, 'teeth_replaced', NULL, '2026-05-18 09:02:06', '2026-05-18 09:02:06'),
(2568, 40, 'permanent_tooth_replacement', NULL, '2026-05-18 09:02:06', '2026-05-18 09:02:06'),
(2569, 40, 'local_anesthesia', NULL, '2026-05-18 09:02:06', '2026-05-18 09:02:06'),
(2570, 40, 'general_anesthesia', NULL, '2026-05-18 09:02:06', '2026-05-18 09:02:06'),
(2571, 40, 'satisfied_appearance_teeth', NULL, '2026-05-18 09:02:06', '2026-05-18 09:02:06'),
(2572, 40, 'keep_natural_teeth', NULL, '2026-05-18 09:02:06', '2026-05-18 09:02:06'),
(2573, 40, 'tense_dental_visits', NULL, '2026-05-18 09:02:06', '2026-05-18 09:02:06'),
(2574, 40, 'calm_nerves', NULL, '2026-05-18 09:02:06', '2026-05-18 09:02:06'),
(2575, 40, 'describe', 'sdsd sdsds', '2026-05-18 09:02:06', '2026-05-18 09:02:06');
INSERT INTO `cdt_form_submission_values` (`id`, `submission_id`, `field_name`, `field_value`, `created_at`, `updated_at`) VALUES
(2576, 40, 'signature', 'signature_40_1779109325.png', '2026-05-18 09:02:06', '2026-05-18 09:02:06'),
(2577, 40, 'print_name', 'Vikash Kumar', '2026-05-18 09:02:06', '2026-05-18 09:02:06'),
(2578, 40, 'location', 'Oakville', '2026-05-18 09:02:06', '2026-05-18 09:02:06'),
(2579, 40, 'consent_privacy_patient', 'Yes', '2026-05-18 09:02:06', '2026-05-18 09:02:06'),
(2580, 40, 'privacy_patient_name', 'Vikash Kumar', '2026-05-18 09:02:06', '2026-05-18 09:02:06'),
(2581, 40, 'consent_newsletter', NULL, '2026-05-18 09:02:06', '2026-05-18 09:02:06'),
(2582, 41, 'title', 'Mr.', '2026-05-18 10:03:52', '2026-05-18 10:03:52'),
(2583, 41, 'full_name', 'John Doe', '2026-05-18 10:03:52', '2026-05-18 10:03:52'),
(2584, 41, 'sex', 'Male', '2026-05-18 10:03:52', '2026-05-18 10:03:52'),
(2585, 41, 'marital_status', 'Single', '2026-05-18 10:03:52', '2026-05-18 10:03:52'),
(2586, 41, 'date_of_birth', '2026-05-01', '2026-05-18 10:03:52', '2026-05-18 10:03:52'),
(2587, 41, 'street_address', '1155 North Service Rd W Suite 11', '2026-05-18 10:03:52', '2026-05-18 10:03:52'),
(2588, 41, 'city', 'Oakville ON', '2026-05-18 10:03:52', '2026-05-18 10:03:52'),
(2589, 41, 'province', 'Oakville', '2026-05-18 10:03:52', '2026-05-18 10:03:52'),
(2590, 41, 'postal_code', 'L6M 3E3', '2026-05-18 10:03:52', '2026-05-18 10:03:52'),
(2591, 41, 'email_address', 'vikash@tastechnologies.com', '2026-05-18 10:03:52', '2026-05-18 10:03:52'),
(2592, 41, 'home_phone', '416-578-0907', '2026-05-18 10:03:52', '2026-05-18 10:03:52'),
(2593, 41, 'cell_phone', '416-578-0907', '2026-05-18 10:03:52', '2026-05-18 10:03:52'),
(2594, 41, 'cccupation', 'NA', '2026-05-18 10:03:52', '2026-05-18 10:03:52'),
(2595, 41, 'employed_by', 'NA', '2026-05-18 10:03:52', '2026-05-18 10:03:52'),
(2596, 41, 'dental_insurance', NULL, '2026-05-18 10:03:52', '2026-05-18 10:03:52'),
(2597, 41, 'insurance_company', 'NA', '2026-05-18 10:03:52', '2026-05-18 10:03:52'),
(2598, 41, 'policy_no', 'NA', '2026-05-18 10:03:52', '2026-05-18 10:03:52'),
(2599, 41, 'certificate_no', 'NA', '2026-05-18 10:03:52', '2026-05-18 10:03:52'),
(2600, 41, 'family_physician', 'NA', '2026-05-18 10:03:52', '2026-05-18 10:03:52'),
(2601, 41, 'physician_phone', 'NA', '2026-05-18 10:03:52', '2026-05-18 10:03:52'),
(2602, 41, 'previous_dentist', 'NA', '2026-05-18 10:03:52', '2026-05-18 10:03:52'),
(2603, 41, 'previous_dentist_phone', 'NA', '2026-05-18 10:03:52', '2026-05-18 10:03:52'),
(2604, 41, 'referral_credit', 'NA', '2026-05-18 10:03:52', '2026-05-18 10:03:52'),
(2605, 41, 'en_contact_name', 'NA', '2026-05-18 10:03:52', '2026-05-18 10:03:52'),
(2606, 41, 'en_relationship', 'NA', '2026-05-18 10:03:52', '2026-05-18 10:03:52'),
(2607, 41, 'en_address', 'NA', '2026-05-18 10:03:52', '2026-05-18 10:03:52'),
(2608, 41, 'en_phone_number', 'NA', '2026-05-18 10:03:52', '2026-05-18 10:03:52'),
(2609, 41, 'dlcp_examination', '2026-05-02', '2026-05-18 10:03:52', '2026-05-18 10:03:52'),
(2610, 41, 'cup_care', 'Yes', '2026-05-18 10:03:52', '2026-05-18 10:03:52'),
(2611, 41, 'cup_care_specify', 'NA', '2026-05-18 10:03:52', '2026-05-18 10:03:52'),
(2612, 41, 'frequent_headaches', 'No', '2026-05-18 10:03:52', '2026-05-18 10:03:52'),
(2613, 41, 'smoke', 'No', '2026-05-18 10:03:52', '2026-05-18 10:03:52'),
(2614, 41, 'drink_alcohol', 'Yes', '2026-05-18 10:03:52', '2026-05-18 10:03:52'),
(2615, 41, 'drink_alcohol_specify', 'NA', '2026-05-18 10:03:52', '2026-05-18 10:03:52'),
(2616, 41, 'recreational_drugs', 'No', '2026-05-18 10:03:52', '2026-05-18 10:03:52'),
(2617, 41, 'herbal_substances', 'Yes', '2026-05-18 10:03:52', '2026-05-18 10:03:52'),
(2618, 41, 'herbal_substances_specify', 'NA', '2026-05-18 10:03:52', '2026-05-18 10:03:52'),
(2619, 41, 'any_medications', 'Yes', '2026-05-18 10:03:52', '2026-05-18 10:03:52'),
(2620, 41, 'any_medications_specify', 'NA', '2026-05-18 10:03:52', '2026-05-18 10:03:52'),
(2621, 41, 'prolonged_medication', 'Yes', '2026-05-18 10:03:52', '2026-05-18 10:03:52'),
(2622, 41, 'prolonged_medication_specify', 'NA', '2026-05-18 10:03:52', '2026-05-18 10:03:52'),
(2623, 41, 'cortisone', 'No', '2026-05-18 10:03:52', '2026-05-18 10:03:52'),
(2624, 41, 'any_surgery', 'Yes', '2026-05-18 10:03:52', '2026-05-18 10:03:52'),
(2625, 41, 'any_surgery_specify', 'NA', '2026-05-18 10:03:52', '2026-05-18 10:03:52'),
(2626, 41, 'ankles_swollen', 'No', '2026-05-18 10:03:52', '2026-05-18 10:03:52'),
(2627, 41, 'gained_lost_weight', 'No', '2026-05-18 10:03:52', '2026-05-18 10:03:52'),
(2628, 41, 'pregnant', 'No', '2026-05-18 10:03:52', '2026-05-18 10:03:52'),
(2629, 41, 'pregnant_weeks', NULL, '2026-05-18 10:03:52', '2026-05-18 10:03:52'),
(2630, 41, 'adverse_reaction', 'Latex, Metals, Sulfa Drugs', '2026-05-18 10:03:52', '2026-05-18 10:03:52'),
(2631, 41, 'allergic_adverse_reaction', 'Aspirin, Local Anesthetic (Freezing), Barbiturates (Sleeping pills), Nitrous Oxide', '2026-05-18 10:03:52', '2026-05-18 10:03:52'),
(2632, 41, 'adverse_reactions', 'Yes', '2026-05-18 10:03:52', '2026-05-18 10:03:52'),
(2633, 41, 'adverse_reactions_specify', 'NA', '2026-05-18 10:03:52', '2026-05-18 10:03:52'),
(2634, 41, 'treated', 'COVID-19, Arthritis, Asthma, Blood Disorder, Anemia, Cardiovascular Disease, Renal Disease, Cancer, Tuberculosis, Epilepsy, Venereal Disease', '2026-05-18 10:03:52', '2026-05-18 10:03:52'),
(2635, 41, 'heavy_bleeding', 'No', '2026-05-18 10:03:52', '2026-05-18 10:03:52'),
(2636, 41, 'anything_else_know', 'Yes', '2026-05-18 10:03:52', '2026-05-18 10:03:52'),
(2637, 41, 'anything_else_know_specify', 'NA', '2026-05-18 10:03:52', '2026-05-18 10:03:52'),
(2638, 41, 'other_disease', 'No', '2026-05-18 10:03:52', '2026-05-18 10:03:52'),
(2639, 41, 'anything_about_health', 'Yes', '2026-05-18 10:03:52', '2026-05-18 10:03:52'),
(2640, 41, 'anything_about_health_specify', 'NA', '2026-05-18 10:03:52', '2026-05-18 10:03:52'),
(2641, 41, 'speak_doctor_privately', 'No', '2026-05-18 10:03:52', '2026-05-18 10:03:52'),
(2642, 41, 'date_last_complete_exam', '2026-05-07', '2026-05-18 10:03:52', '2026-05-18 10:03:52'),
(2643, 41, 'date_last_cleaning', '2026-05-08', '2026-05-18 10:03:52', '2026-05-18 10:03:52'),
(2644, 41, 'date_last_x_rays', '2026-05-09', '2026-05-18 10:03:52', '2026-05-18 10:03:52'),
(2645, 41, 'last_dentist_regularly', 'Yes', '2026-05-18 10:03:52', '2026-05-18 10:03:52'),
(2646, 41, 'last_dentist', '3 Months', '2026-05-18 10:03:52', '2026-05-18 10:03:52'),
(2647, 41, 'last_dentist_description', 'NA', '2026-05-18 10:03:52', '2026-05-18 10:03:52'),
(2648, 41, 'antibiotics', 'No', '2026-05-18 10:03:52', '2026-05-18 10:03:52'),
(2649, 41, 'heavy_bleeding_extractions', 'No', '2026-05-18 10:03:52', '2026-05-18 10:03:52'),
(2650, 41, 'gum_treatment', 'No', '2026-05-18 10:03:52', '2026-05-18 10:03:52'),
(2651, 41, 'orthodontic_treatment', 'No', '2026-05-18 10:03:52', '2026-05-18 10:03:52'),
(2652, 41, 'unpleasant_dental_experience', 'No', '2026-05-18 10:03:52', '2026-05-18 10:03:52'),
(2653, 41, 'age', '22', '2026-05-18 10:03:52', '2026-05-18 10:03:52'),
(2654, 41, 'pleasant_dental_experience', 'NA', '2026-05-18 10:03:52', '2026-05-18 10:03:52'),
(2655, 41, 'anything_else_should_know', 'NA', '2026-05-18 10:03:52', '2026-05-18 10:03:52'),
(2656, 41, 'brings_office_today', 'NA', '2026-05-18 10:03:52', '2026-05-18 10:03:52'),
(2657, 41, 'any_discomfort', 'Yes', '2026-05-18 10:03:52', '2026-05-18 10:03:52'),
(2658, 41, 'any_discomfort_specify', 'NA', '2026-05-18 10:03:52', '2026-05-18 10:03:52'),
(2659, 41, 'have_experienced', 'Tooth sensitivity, Bad breath, Headaches, Bleeding gums, Gagging, Loose Teeth, Lump or swelling in your mouth, Clench or Grind, Emphysema, Tuberculosis, Epilepsy, Venereal Disease', '2026-05-18 10:03:52', '2026-05-18 10:03:52'),
(2660, 41, 'food_teeth', 'No', '2026-05-18 10:03:52', '2026-05-18 10:03:52'),
(2661, 41, 'sore_spots', 'No', '2026-05-18 10:03:52', '2026-05-18 10:03:52'),
(2662, 41, 'teeth_replaced', 'No', '2026-05-18 10:03:52', '2026-05-18 10:03:52'),
(2663, 41, 'permanent_tooth_replacement', 'No', '2026-05-18 10:03:52', '2026-05-18 10:03:52'),
(2664, 41, 'local_anesthesia', 'No', '2026-05-18 10:03:52', '2026-05-18 10:03:52'),
(2665, 41, 'general_anesthesia', 'No', '2026-05-18 10:03:52', '2026-05-18 10:03:52'),
(2666, 41, 'satisfied_appearance_teeth', 'No', '2026-05-18 10:03:52', '2026-05-18 10:03:52'),
(2667, 41, 'keep_natural_teeth', 'No', '2026-05-18 10:03:52', '2026-05-18 10:03:52'),
(2668, 41, 'tense_dental_visits', 'No', '2026-05-18 10:03:52', '2026-05-18 10:03:52'),
(2669, 41, 'calm_nerves', 'No', '2026-05-18 10:03:52', '2026-05-18 10:03:52'),
(2670, 41, 'describe', 'Just for testing purpose, please ignore it.', '2026-05-18 10:03:52', '2026-05-18 10:03:52'),
(2671, 41, 'signature', 'signature_41_1779113032.png', '2026-05-18 10:03:52', '2026-05-18 10:03:52'),
(2672, 41, 'print_name', 'John Doe', '2026-05-18 10:03:52', '2026-05-18 10:03:52'),
(2673, 41, 'location', 'Mississauga', '2026-05-18 10:03:52', '2026-05-18 10:03:52'),
(2674, 41, 'consent_privacy_patient', 'Yes', '2026-05-18 10:03:52', '2026-05-18 10:03:52'),
(2675, 41, 'privacy_patient_name', 'John Doe', '2026-05-18 10:03:52', '2026-05-18 10:03:52'),
(2676, 41, 'consent_newsletter', NULL, '2026-05-18 10:03:52', '2026-05-18 10:03:52');

-- --------------------------------------------------------

--
-- Table structure for table `cdt_migrations`
--

CREATE TABLE `cdt_migrations` (
  `id` int UNSIGNED NOT NULL,
  `migration` varchar(255) COLLATE utf8mb4_unicode_ci NOT NULL,
  `batch` int NOT NULL
) ENGINE=InnoDB DEFAULT CHARSET=utf8mb4 COLLATE=utf8mb4_unicode_ci;

--
-- Dumping data for table `cdt_migrations`
--

INSERT INTO `cdt_migrations` (`id`, `migration`, `batch`) VALUES
(1, '2014_10_12_100000_create_password_reset_tokens_table', 1),
(2, '2019_08_19_000000_create_failed_jobs_table', 1),
(3, '2019_12_14_000001_create_personal_access_tokens_table', 1),
(4, '2025_07_16_103106_create_admin_table', 1),
(5, '2025_07_16_183311_create_settings_table', 1),
(6, '2025_07_16_200704_create_admin_role_table', 1),
(7, '2025_07_16_200730_create_modules_table', 1),
(8, '2025_07_16_201200_create_role_module_method_rights_table', 1),
(9, '2025_07_16_220024_create_module_methods_table', 1),
(10, '2025_07_16_222609_create_module_class_table', 1),
(11, '2025_08_16_033725_create_seo_meta_table', 1),
(12, '2025_08_26_023125_create_admin_access_logs_table', 1),
(13, '2025_10_02_103106_create_email_template_table', 1),
(14, '2025_10_08_222112_create_template_table', 1),
(15, '2025_10_13_222112_create_custom_field_table', 1),
(16, '2025_10_16_201200_create_custom_field_group_custom_field_table', 1),
(17, '2025_10_16_201200_create_custom_field_group_template_table', 1),
(18, '2025_10_16_222112_create_custom_field_group_table', 1),
(19, '2025_10_17_103106_create_page_table', 1),
(20, '2025_10_17_201200_create_custom_field_value_table', 1),
(21, '2025_11_18_103106_create_clinics_table', 1),
(22, '2025_12_02_215237_create_forms_table', 1),
(23, '2025_12_02_221759_create_form_fields_table', 1),
(24, '2025_12_02_221948_create_form_submissions_table', 1),
(25, '2025_12_02_222320_create_form_submission_values_table', 1);

-- --------------------------------------------------------

--
-- Table structure for table `cdt_modules`
--

CREATE TABLE `cdt_modules` (
  `module_id` int UNSIGNED NOT NULL,
  `class_id` int NOT NULL,
  `has_templates` enum('yes','no') COLLATE utf8mb4_unicode_ci NOT NULL,
  `title` varchar(128) COLLATE utf8mb4_unicode_ci NOT NULL,
  `label` varchar(255) COLLATE utf8mb4_unicode_ci DEFAULT NULL,
  `info` text COLLATE utf8mb4_unicode_ci,
  `class_name` varchar(191) COLLATE utf8mb4_unicode_ci NOT NULL,
  `is_menu` enum('yes','no') COLLATE utf8mb4_unicode_ci NOT NULL DEFAULT 'yes',
  `icon_class` varchar(40) COLLATE utf8mb4_unicode_ci DEFAULT NULL,
  `hot_text` varchar(20) COLLATE utf8mb4_unicode_ci DEFAULT NULL,
  `c_order` int NOT NULL DEFAULT '0',
  `parent_module_id` int NOT NULL DEFAULT '0',
  `status` enum('enabled','disabled') COLLATE utf8mb4_unicode_ci NOT NULL DEFAULT 'enabled'
) ENGINE=InnoDB DEFAULT CHARSET=utf8mb4 COLLATE=utf8mb4_unicode_ci;

--
-- Dumping data for table `cdt_modules`
--

INSERT INTO `cdt_modules` (`module_id`, `class_id`, `has_templates`, `title`, `label`, `info`, `class_name`, `is_menu`, `icon_class`, `hot_text`, `c_order`, `parent_module_id`, `status`) VALUES
(1, 1, 'no', 'Dashboard', 'Dashboard', NULL, 'DashboardController', 'yes', 'ri-dashboard-2-line', '', 1, 0, 'enabled'),
(2, 2, 'no', 'Common', 'Common', NULL, 'BaseController', 'no', '', '', 0, 0, 'enabled'),
(3, 3, 'no', 'Admin Users', 'Admin Users', NULL, 'AdminController', 'yes', 'ri-account-circle-line', '', 100, 0, 'enabled'),
(4, 4, 'no', 'Admin Users Role', 'Admin Users Role', NULL, 'AdminRoleController', 'no', '', '', 0, 3, 'enabled'),
(5, 5, 'no', 'Settings', 'Settings', NULL, 'SettingsController', 'yes', 'ri-settings-2-line', '', 99, 0, 'enabled'),
(11, 11, 'no', 'System > Email Templates', 'System', NULL, 'EmailTemplateController', 'yes', '', '', 98, 0, 'enabled'),
(12, 12, 'no', 'System > Custom Field Groups', 'Custom Field Groups', NULL, 'CustomFieldGroupController', 'yes', '', '', 2, 11, 'enabled'),
(13, 13, 'no', 'System > Custom Fields', 'Custom Fields', NULL, 'CustomFieldController', 'yes', '', '', 3, 11, 'enabled'),
(14, 14, 'no', 'System > Templates', 'Templates', NULL, 'TemplateController', 'yes', '', '', 4, 11, 'enabled'),
(15, 15, 'yes', 'Pages', 'Pages', NULL, 'PageController', 'yes', 'ri-pages-line', '', 97, 0, 'enabled'),
(16, 16, 'no', 'Enquiries > Contact Us', 'Enquiries', NULL, 'EnquiryController', 'yes', 'ri-file-list-3-line', '', 2, 0, 'enabled'),
(56, 56, 'no', 'Clinics', 'Clinics', NULL, 'ClinicController', 'yes', 'ri-hospital-line', '', 4, 0, 'enabled'),
(59, 59, 'no', 'Enquiries > Book Appointment', 'Book Appointment', NULL, 'BookAppointmentController', 'yes', '', '', 2, 16, 'enabled');

-- --------------------------------------------------------

--
-- Table structure for table `cdt_module_class`
--

CREATE TABLE `cdt_module_class` (
  `class_id` int UNSIGNED NOT NULL,
  `class_name` varchar(191) COLLATE utf8mb4_unicode_ci NOT NULL,
  `model_name` varchar(255) COLLATE utf8mb4_unicode_ci NOT NULL,
  `slug` varchar(100) COLLATE utf8mb4_unicode_ci NOT NULL,
  `info` text COLLATE utf8mb4_unicode_ci,
  `status` enum('enabled','disabled') COLLATE utf8mb4_unicode_ci NOT NULL DEFAULT 'enabled'
) ENGINE=InnoDB DEFAULT CHARSET=utf8mb4 COLLATE=utf8mb4_unicode_ci;

--
-- Dumping data for table `cdt_module_class`
--

INSERT INTO `cdt_module_class` (`class_id`, `class_name`, `model_name`, `slug`, `info`, `status`) VALUES
(1, 'DashboardController', 'Dashboard', 'dashboard', NULL, 'enabled'),
(2, 'BaseController', 'Base', 'base', NULL, 'enabled'),
(3, 'AdminController', 'Admin', 'admin', NULL, 'enabled'),
(4, 'AdminRoleController', 'AdminRole', 'admin-role', NULL, 'enabled'),
(5, 'SettingsController', 'Settings', 'settings', NULL, 'enabled'),
(11, 'EmailTemplateController', 'EmailTemplate', 'email-template', NULL, 'enabled'),
(12, 'CustomFieldGroupController', 'CustomFieldGroup', 'custom-field-group', NULL, 'enabled'),
(13, 'CustomFieldController', 'CustomField', 'custom-field', NULL, 'enabled'),
(14, 'TemplateController', 'Template', 'template', NULL, 'enabled'),
(15, 'PageController', 'Page', 'page', NULL, 'enabled'),
(16, 'EnquiryController', 'Enquiries', 'enquiry', NULL, 'enabled'),
(56, 'ClinicController', 'Clinics', 'clinic', NULL, 'enabled'),
(59, 'BookAppointmentController', 'Enquiries', 'book-appointment', NULL, 'enabled');

-- --------------------------------------------------------

--
-- Table structure for table `cdt_module_methods`
--

CREATE TABLE `cdt_module_methods` (
  `method_id` int UNSIGNED NOT NULL,
  `module_id` tinyint NOT NULL,
  `title` varchar(255) COLLATE utf8mb4_unicode_ci NOT NULL,
  `method_name` varchar(255) COLLATE utf8mb4_unicode_ci DEFAULT NULL,
  `default_present` tinyint NOT NULL DEFAULT '0',
  `access_role_id` int NOT NULL DEFAULT '0' COMMENT '0=access to all',
  `route_link` varchar(255) COLLATE utf8mb4_unicode_ci NOT NULL,
  `affected_route_link` varchar(255) COLLATE utf8mb4_unicode_ci DEFAULT NULL,
  `is_left_nav` tinyint NOT NULL DEFAULT '1',
  `is_external_link` tinyint NOT NULL DEFAULT '0',
  `c_order` int NOT NULL DEFAULT '0',
  `updated_id` int NOT NULL DEFAULT '0',
  `created_at` timestamp NULL DEFAULT NULL,
  `updated_at` timestamp NULL DEFAULT NULL
) ENGINE=InnoDB DEFAULT CHARSET=utf8mb4 COLLATE=utf8mb4_unicode_ci;

--
-- Dumping data for table `cdt_module_methods`
--

INSERT INTO `cdt_module_methods` (`method_id`, `module_id`, `title`, `method_name`, `default_present`, `access_role_id`, `route_link`, `affected_route_link`, `is_left_nav`, `is_external_link`, `c_order`, `updated_id`, `created_at`, `updated_at`) VALUES
(1, 1, 'Dashboard', 'show', 1, 0, 'admin.dashboard', NULL, 1, 0, 1, 1, '2026-05-01 02:01:41', NULL),
(2, 2, 'Common Status', 'changestatus', 1, 0, 'admin.changestatus', 'admin.dashboard', 0, 0, 0, 1, '2026-05-01 02:01:41', NULL),
(3, 2, 'Common Delete Seo Image', 'deleteSeoImage', 1, 0, 'admin.seo.deleteimage', 'admin.dashboard', 0, 0, 0, 1, '2026-05-01 02:01:41', NULL),
(4, 2, 'Common Delete Custom Field Value File', 'deleteSeoImage', 1, 0, 'admin.customfieldvalue.deletefile', 'admin.dashboard', 0, 0, 0, 1, '2026-05-01 02:01:41', NULL),
(21, 3, 'Edit Profile', 'editprofile', 0, 0, 'admin.profile', NULL, 0, 0, 0, 1, '2026-05-01 02:01:41', NULL),
(22, 3, 'Update Profile', 'updateprofile', 0, 0, 'admin.profile.update', 'admin.profile', 0, 0, 0, 1, '2026-05-01 02:01:41', NULL),
(23, 3, 'Delete User Image', 'deleteFile', 0, 0, 'admin.profile.deletefile', 'admin.profile', 0, 0, 0, 1, '2026-05-01 02:01:41', NULL),
(24, 3, 'All Users', 'index', 0, 0, 'admin.admin.index', NULL, 1, 0, 1, 1, '2026-05-01 02:01:41', NULL),
(25, 3, 'Add User', 'create', 0, 0, 'admin.admin.create', NULL, 1, 0, 2, 1, '2026-05-01 02:01:41', NULL),
(26, 3, 'Store User', 'store', 0, 0, 'admin.admin.store', 'admin.admin.create', 0, 0, 0, 1, '2026-05-01 02:01:41', NULL),
(27, 3, 'Edit User', 'edit', 0, 0, 'admin.admin.edit', NULL, 0, 0, 0, 1, '2026-05-01 02:01:41', NULL),
(28, 3, 'Update User', 'update', 0, 0, 'admin.admin.update', 'admin.admin.edit', 0, 0, 0, 1, '2026-05-01 02:01:41', NULL),
(29, 3, 'Delete User', 'deleteData', 0, 0, 'admin.admin.delete', NULL, 0, 0, 0, 1, '2026-05-01 02:01:41', NULL),
(30, 3, 'Delete User Image', 'deleteFile', 0, 0, 'admin.admin.deletefile', 'admin.admin.update', 0, 0, 0, 1, '2026-05-01 02:01:41', NULL),
(41, 4, 'User Roles', 'index', 0, 0, 'admin.admin-role.index', NULL, 1, 0, 1, 1, '2026-05-01 02:01:41', NULL),
(42, 4, 'Add Role', 'create', 0, 0, 'admin.admin-role.create', NULL, 0, 0, 0, 1, '2026-05-01 02:01:41', NULL),
(43, 4, 'Store Role', 'store', 0, 0, 'admin.admin-role.store', 'admin.admin-role.create', 0, 0, 0, 1, '2026-05-01 02:01:41', NULL),
(44, 4, 'Edit Role', 'edit', 0, 0, 'admin.admin-role.edit', NULL, 0, 0, 0, 1, '2026-05-01 02:01:41', NULL),
(45, 4, 'Update Role', 'update', 0, 0, 'admin.admin-role.update', 'admin.admin-role.edit', 0, 0, 0, 1, '2026-05-01 02:01:41', NULL),
(46, 4, 'Delete Role', 'deleteData', 0, 0, 'admin.admin-role.delete', NULL, 0, 0, 0, 1, '2026-05-01 02:01:41', NULL),
(51, 5, 'General', 'editGeneral', 0, 0, 'admin.settings.general', NULL, 1, 0, 1, 1, '2026-05-01 02:01:41', NULL),
(52, 5, 'General Update', 'updateGeneral', 0, 0, 'admin.settings.general.update', 'admin.settings.general', 0, 0, 0, 1, '2026-05-01 02:01:41', NULL),
(53, 5, 'Mail', 'editMail', 0, 0, 'admin.settings.mail', NULL, 1, 0, 2, 1, '2026-05-01 02:01:41', NULL),
(54, 5, 'Mail Update', 'updateMail', 0, 0, 'admin.settings.mail.update', 'admin.settings.mail', 0, 0, 0, 1, '2026-05-01 02:01:41', NULL),
(55, 5, 'Delete File', 'deletefile', 0, 0, 'admin.settings.deletefile', 'admin.settings.general', 0, 0, 0, 1, '2026-05-01 02:01:41', NULL),
(111, 11, 'Email Templates', 'index', 0, 0, 'admin.email-template.index', NULL, 1, 0, 0, 1, '2026-05-01 02:01:41', NULL),
(112, 11, 'Add Email Template', 'create', 0, 0, 'admin.email-template.create', NULL, 0, 0, 0, 1, '2026-05-01 02:01:41', NULL),
(113, 11, 'Store Email Template', 'store', 0, 0, 'admin.email-template.store', 'admin.email-template.create', 0, 0, 0, 1, '2026-05-01 02:01:41', NULL),
(114, 11, 'Edit Email Template', 'edit', 0, 0, 'admin.email-template.edit', NULL, 0, 0, 0, 1, '2026-05-01 02:01:41', NULL),
(115, 11, 'Update Email Template', 'update', 0, 0, 'admin.email-template.update', 'admin.email-template.edit', 0, 0, 0, 1, '2026-05-01 02:01:41', NULL),
(116, 11, 'Delete Email Template', 'deleteData', 0, 0, 'admin.email-template.delete', NULL, 0, 0, 0, 1, '2026-05-01 02:01:41', NULL),
(121, 12, 'Custom Field Groups', 'index', 0, 0, 'admin.custom-field-group.index', NULL, 1, 0, 0, 1, '2026-05-01 02:01:41', NULL),
(122, 12, 'Add Custom Field Group', 'create', 0, 0, 'admin.custom-field-group.create', NULL, 0, 0, 0, 1, '2026-05-01 02:01:41', NULL),
(123, 12, 'Store Custom Field Group', 'store', 0, 0, 'admin.custom-field-group.store', 'admin.custom-field-group.create', 0, 0, 0, 1, '2026-05-01 02:01:41', NULL),
(124, 12, 'Edit Custom Field Group', 'edit', 0, 0, 'admin.custom-field-group.edit', NULL, 0, 0, 0, 1, '2026-05-01 02:01:41', NULL),
(125, 12, 'Update Custom Field Group', 'update', 0, 0, 'admin.custom-field-group.update', 'admin.custom-field-group.edit', 0, 0, 0, 1, '2026-05-01 02:01:41', NULL),
(126, 12, 'Delete Custom Field Group', 'deleteData', 0, 0, 'admin.custom-field-group.delete', NULL, 0, 0, 0, 1, '2026-05-01 02:01:41', NULL),
(131, 13, 'Custom fields', 'index', 0, 0, 'admin.custom-field.index', NULL, 1, 0, 0, 1, '2026-05-01 02:01:41', NULL),
(132, 13, 'Add Custom field', 'create', 0, 0, 'admin.custom-field.create', NULL, 0, 0, 0, 1, '2026-05-01 02:01:41', NULL),
(133, 13, 'Store Custom field', 'store', 0, 0, 'admin.custom-field.store', 'admin.custom-field.create', 0, 0, 0, 1, '2026-05-01 02:01:41', NULL),
(134, 13, 'Edit Custom field', 'edit', 0, 0, 'admin.custom-field.edit', NULL, 0, 0, 0, 1, '2026-05-01 02:01:41', NULL),
(135, 13, 'Update Custom field', 'update', 0, 0, 'admin.custom-field.update', 'admin.custom-field.edit', 0, 0, 0, 1, '2026-05-01 02:01:41', NULL),
(136, 13, 'Delete Custom field', 'deleteData', 0, 0, 'admin.custom-field.delete', NULL, 0, 0, 0, 1, '2026-05-01 02:01:41', NULL),
(141, 14, 'Templates', 'index', 0, 0, 'admin.template.index', NULL, 1, 0, 0, 1, '2026-05-01 02:01:41', NULL),
(142, 14, 'Add Template', 'create', 0, 0, 'admin.template.create', NULL, 0, 0, 0, 1, '2026-05-01 02:01:41', NULL),
(143, 14, 'Store Template', 'store', 0, 0, 'admin.template.store', 'admin.template.create', 0, 0, 0, 1, '2026-05-01 02:01:41', NULL),
(144, 14, 'Edit Template', 'edit', 0, 0, 'admin.template.edit', NULL, 0, 0, 0, 1, '2026-05-01 02:01:41', NULL),
(145, 14, 'Update Template', 'update', 0, 0, 'admin.template.update', 'admin.template.edit', 0, 0, 0, 1, '2026-05-01 02:01:41', NULL),
(146, 14, 'Delete Template', 'deleteData', 0, 0, 'admin.template.delete', NULL, 0, 0, 0, 1, '2026-05-01 02:01:41', NULL),
(151, 15, 'All Pages', 'index', 0, 0, 'admin.page.index', NULL, 1, 0, 1, 1, '2026-05-01 02:01:41', NULL),
(152, 15, 'Add Page', 'create', 0, 0, 'admin.page.create', NULL, 1, 0, 2, 1, '2026-05-01 02:01:41', NULL),
(153, 15, 'Store Page', 'store', 0, 0, 'admin.page.store', 'admin.page.create', 0, 0, 0, 1, '2026-05-01 02:01:41', NULL),
(154, 15, 'Edit Page', 'edit', 0, 0, 'admin.page.edit', NULL, 0, 0, 0, 1, '2026-05-01 02:01:41', NULL),
(155, 15, 'Update Page', 'update', 0, 0, 'admin.page.update', 'admin.page.edit', 0, 0, 0, 1, '2026-05-01 02:01:41', NULL),
(156, 15, 'Delete Page', 'deleteData', 0, 0, 'admin.page.delete', NULL, 0, 0, 0, 1, '2026-05-01 02:01:41', NULL),
(157, 15, 'Delete Page Image', 'deleteFile', 0, 0, 'admin.page.deletefile', 'admin.page.edit', 0, 0, 0, 1, '2026-05-01 02:01:41', NULL),
(161, 16, 'Contact Us', 'index', 0, 0, 'admin.enquiry.index', NULL, 1, 0, 1, 1, '2026-05-01 02:01:41', NULL),
(162, 16, 'View Contact Us Enquiry', 'view', 0, 0, 'admin.enquiry.show', NULL, 0, 0, 0, 1, '2026-05-01 02:01:41', NULL),
(163, 16, 'Export Contact Us Enquiry', 'export', 0, 0, 'admin.enquiry.export', 'admin.enquiry.index', 0, 0, 0, 1, '2026-05-01 02:01:41', NULL),
(164, 16, 'Delete Contact Us Enquiry', 'deleteData', 0, 0, 'admin.enquiry.delete', NULL, 0, 0, 0, 1, '2026-05-01 02:01:41', NULL),
(561, 56, 'All Clinics', 'index', 0, 0, 'admin.clinic.index', NULL, 1, 0, 1, 1, '2026-05-01 02:01:41', NULL),
(562, 56, 'Add Clinic', 'create', 0, 0, 'admin.clinic.create', NULL, 1, 0, 2, 1, '2026-05-01 02:01:41', NULL),
(563, 56, 'Store Clinic', 'store', 0, 0, 'admin.clinic.store', 'admin.clinic.create', 0, 0, 0, 1, '2026-05-01 02:01:41', NULL),
(564, 56, 'Edit Clinic', 'edit', 0, 0, 'admin.clinic.edit', NULL, 0, 0, 0, 1, '2026-05-01 02:01:41', NULL),
(565, 56, 'Update Clinic', 'update', 0, 0, 'admin.clinic.update', 'admin.clinic.edit', 0, 0, 0, 1, '2026-05-01 02:01:41', NULL),
(566, 56, 'Delete Clinic', 'deleteData', 0, 0, 'admin.clinic.delete', NULL, 0, 0, 0, 1, '2026-05-01 02:01:41', NULL),
(567, 56, 'Delete Clinic Image', 'deleteFile', 0, 0, 'admin.clinic.deletefile', 'admin.clinic.edit', 0, 0, 0, 1, '2026-05-01 02:01:41', NULL),
(591, 59, 'Book Appointment', 'index', 0, 0, 'admin.book-appointment.index', NULL, 1, 0, 1, 1, '2026-05-01 02:01:41', NULL),
(592, 59, 'View Book Appointment Enquiry', 'view', 0, 0, 'admin.book-appointment.show', NULL, 0, 0, 0, 1, '2026-05-01 02:01:41', NULL),
(593, 59, 'Export Book Appointment Enquiry', 'export', 0, 0, 'admin.book-appointment.export', 'admin.book-appointment.index', 0, 0, 0, 1, '2026-05-01 02:01:41', NULL),
(594, 59, 'Delete Book Appointment Enquiry', 'deleteData', 0, 0, 'admin.book-appointment.delete', NULL, 0, 0, 0, 1, '2026-05-01 02:01:41', NULL);

-- --------------------------------------------------------

--
-- Table structure for table `cdt_page`
--

CREATE TABLE `cdt_page` (
  `page_id` int UNSIGNED NOT NULL,
  `title` varchar(255) COLLATE utf8mb4_unicode_ci NOT NULL,
  `slug` varchar(255) COLLATE utf8mb4_unicode_ci NOT NULL,
  `description` text COLLATE utf8mb4_unicode_ci,
  `image` varchar(255) COLLATE utf8mb4_unicode_ci DEFAULT NULL,
  `parent_id` int NOT NULL DEFAULT '0',
  `template_id` int NOT NULL,
  `note` varchar(255) COLLATE utf8mb4_unicode_ci DEFAULT NULL,
  `c_order` int NOT NULL DEFAULT '0',
  `status` enum('enabled','disabled') COLLATE utf8mb4_unicode_ci NOT NULL DEFAULT 'enabled',
  `created_id` int NOT NULL DEFAULT '0',
  `updated_id` int NOT NULL DEFAULT '0',
  `created_at` timestamp NULL DEFAULT NULL,
  `updated_at` timestamp NULL DEFAULT NULL
) ENGINE=InnoDB DEFAULT CHARSET=utf8mb4 COLLATE=utf8mb4_unicode_ci;

--
-- Dumping data for table `cdt_page`
--

INSERT INTO `cdt_page` (`page_id`, `title`, `slug`, `description`, `image`, `parent_id`, `template_id`, `note`, `c_order`, `status`, `created_id`, `updated_id`, `created_at`, `updated_at`) VALUES
(1, 'Home', 'home', NULL, NULL, 0, 1, NULL, 0, 'enabled', 1, 1, '2026-05-01 02:24:30', '2026-05-01 02:24:30'),
(2, 'Thank You!', 'ty-quick-appointment', '<h6>Success! Your form has been submitted. We\'ll be in touch shortly</h6>', NULL, 0, 2, 'Used for Quick Book Appointment Form', 0, 'enabled', 1, 1, '2026-05-01 11:27:08', '2026-05-02 10:49:21'),
(3, 'Services', 'services', NULL, NULL, 0, 3, NULL, 0, 'enabled', 1, 1, '2026-05-01 13:33:41', '2026-05-01 13:33:41'),
(4, 'Bonding', 'bonding', NULL, NULL, 3, 4, NULL, 1, 'enabled', 1, 1, '2026-05-01 13:34:15', '2026-05-01 13:34:15'),
(5, 'Thank You!', 'ty-book-appointment', '<h6>Success! Your form has been submitted. We\'ll be in touch shortly</h6>', NULL, 0, 2, 'Used for Book Appointment Form', 0, 'enabled', 1, 1, '2026-05-02 02:32:16', '2026-05-02 10:49:35'),
(6, 'Book Appointment', 'book-appointment', NULL, NULL, 0, 5, NULL, 0, 'enabled', 1, 1, '2026-05-02 02:42:19', '2026-05-02 02:42:19'),
(7, 'CEREC Crowns', 'cerec-crowns', NULL, NULL, 3, 4, NULL, 2, 'enabled', 1, 1, '2026-05-02 03:55:00', '2026-05-02 07:45:52'),
(8, 'Children\'s Dentistry', 'childrens-dentistry', NULL, NULL, 3, 4, NULL, 3, 'enabled', 1, 1, '2026-05-02 06:20:40', '2026-05-02 06:20:40'),
(9, 'Cosmetic Dentistry', 'cosmetic-dentistry', NULL, NULL, 3, 4, NULL, 4, 'enabled', 1, 1, '2026-05-02 06:30:18', '2026-05-02 06:30:18'),
(10, 'Dental Bridges', 'dental-bridges', NULL, NULL, 3, 4, NULL, 5, 'enabled', 1, 1, '2026-05-02 06:36:20', '2026-05-02 06:36:20'),
(11, 'Dental Crowns', 'dental-crowns', NULL, NULL, 3, 4, NULL, 6, 'enabled', 1, 1, '2026-05-02 06:42:16', '2026-05-02 06:42:16'),
(12, 'Dental Implants', 'dental-implants', NULL, NULL, 3, 4, NULL, 7, 'enabled', 1, 1, '2026-05-02 06:51:52', '2026-05-02 06:51:52'),
(13, 'Denture Services', 'denture-services', NULL, NULL, 3, 4, NULL, 8, 'enabled', 1, 1, '2026-05-02 06:56:51', '2026-05-02 06:56:51'),
(14, 'Endodontics', 'endodontics', NULL, NULL, 3, 4, NULL, 9, 'enabled', 1, 1, '2026-05-02 07:01:26', '2026-05-02 07:01:26'),
(15, 'Gum Disease', 'gum-disease', NULL, NULL, 3, 4, NULL, 10, 'enabled', 1, 1, '2026-05-02 07:07:08', '2026-05-02 07:07:08'),
(16, 'Invisalign', 'invisalign', NULL, NULL, 3, 3, NULL, 11, 'enabled', 1, 1, '2026-05-02 07:16:26', '2026-05-02 07:16:26'),
(17, 'Orthodontics', 'orthodontics', NULL, NULL, 3, 4, NULL, 12, 'enabled', 1, 1, '2026-05-02 07:18:16', '2026-05-02 07:18:16'),
(18, 'Porcelain Veneers', 'porcelain-veneers', NULL, NULL, 3, 4, NULL, 13, 'enabled', 1, 1, '2026-05-02 07:22:36', '2026-05-02 07:22:36'),
(19, 'Restorative Dentistry', 'restorative-dentistry', NULL, NULL, 3, 4, NULL, 14, 'enabled', 1, 1, '2026-05-02 07:29:15', '2026-05-02 07:29:15'),
(20, 'Root Canal Treatment', 'root-canal-treatment', NULL, NULL, 3, 4, NULL, 15, 'enabled', 1, 1, '2026-05-02 07:33:40', '2026-05-02 07:33:40'),
(21, 'Sedation Dentistry', 'sedation-dentistry', NULL, NULL, 3, 4, NULL, 16, 'enabled', 1, 1, '2026-05-02 07:37:48', '2026-05-02 07:37:48'),
(22, 'Teeth Whitening', 'teeth-whitening', NULL, NULL, 3, 4, NULL, 17, 'enabled', 1, 1, '2026-05-02 07:41:48', '2026-05-02 07:41:48'),
(23, 'About Us', 'about-us', NULL, NULL, 0, 6, NULL, 0, 'enabled', 1, 1, '2026-05-02 07:48:34', '2026-05-02 07:48:34'),
(24, 'Our Locations', 'our-locations', NULL, NULL, 0, 7, NULL, 0, 'enabled', 1, 1, '2026-05-02 08:12:27', '2026-05-02 08:12:27'),
(25, 'Reviews', 'reviews', NULL, NULL, 0, 9, NULL, 0, 'enabled', 1, 1, '2026-05-02 08:13:10', '2026-05-02 08:13:10'),
(26, 'Thank You!', 'ty-contact-us', '<h6>Success! Your form has been submitted. We\'ll be in touch shortly</h6>', NULL, 0, 2, 'Used for Contact Us Form Page', 0, 'enabled', 1, 1, '2026-05-02 10:48:12', '2026-05-02 10:48:12'),
(27, 'Oakville Dentist', 'oakville-dentist', NULL, NULL, 0, 10, NULL, 0, 'enabled', 1, 1, '2026-05-08 23:33:28', '2026-05-08 23:33:28'),
(28, 'Burlington Dentist', 'burlington-dentist', NULL, NULL, 0, 11, NULL, 0, 'enabled', 1, 1, '2026-05-08 23:33:53', '2026-05-08 23:33:53'),
(29, 'Mississauga Dentist', 'mississauga-dentist', NULL, NULL, 0, 12, NULL, 0, 'enabled', 1, 1, '2026-05-08 23:34:08', '2026-05-08 23:34:08'),
(30, 'Oakville New Patient Form', 'oakville', NULL, NULL, 0, 13, NULL, 0, 'enabled', 1, 1, '2026-05-13 09:34:04', '2026-05-13 09:47:14'),
(31, 'Burlington New Patient Form', 'burlington', NULL, NULL, 0, 13, NULL, 0, 'enabled', 1, 1, '2026-05-13 09:34:04', '2026-05-13 09:47:14'),
(32, 'Mississauga New Patient Form', 'mississauga', NULL, NULL, 0, 13, NULL, 0, 'enabled', 1, 1, '2026-05-13 09:34:04', '2026-05-13 09:47:14'),
(33, 'Thank You!', 'ty-new-patient-form', '<h6>Success! Your form has been submitted. We\'ll be in touch shortly</h6>', NULL, 0, 2, 'Used for New Patient Form Page', 0, 'enabled', 1, 1, '2026-05-14 10:48:12', '2026-05-14 10:48:12');

-- --------------------------------------------------------

--
-- Table structure for table `cdt_password_reset_tokens`
--

CREATE TABLE `cdt_password_reset_tokens` (
  `email` varchar(255) COLLATE utf8mb4_unicode_ci NOT NULL,
  `token` varchar(255) COLLATE utf8mb4_unicode_ci NOT NULL,
  `created_at` timestamp NULL DEFAULT NULL
) ENGINE=InnoDB DEFAULT CHARSET=utf8mb4 COLLATE=utf8mb4_unicode_ci;

-- --------------------------------------------------------

--
-- Table structure for table `cdt_personal_access_tokens`
--

CREATE TABLE `cdt_personal_access_tokens` (
  `id` bigint UNSIGNED NOT NULL,
  `tokenable_type` varchar(255) COLLATE utf8mb4_unicode_ci NOT NULL,
  `tokenable_id` bigint UNSIGNED NOT NULL,
  `name` varchar(255) COLLATE utf8mb4_unicode_ci NOT NULL,
  `token` varchar(64) COLLATE utf8mb4_unicode_ci NOT NULL,
  `abilities` text COLLATE utf8mb4_unicode_ci,
  `last_used_at` timestamp NULL DEFAULT NULL,
  `expires_at` timestamp NULL DEFAULT NULL,
  `created_at` timestamp NULL DEFAULT NULL,
  `updated_at` timestamp NULL DEFAULT NULL
) ENGINE=InnoDB DEFAULT CHARSET=utf8mb4 COLLATE=utf8mb4_unicode_ci;

-- --------------------------------------------------------

--
-- Table structure for table `cdt_role_module_method_rights`
--

CREATE TABLE `cdt_role_module_method_rights` (
  `role_module_method_right_id` int UNSIGNED NOT NULL,
  `role_id` int NOT NULL,
  `module_id` int NOT NULL,
  `method_id` int NOT NULL,
  `created_at` timestamp NULL DEFAULT NULL,
  `updated_at` timestamp NULL DEFAULT NULL,
  `deleted_at` timestamp NULL DEFAULT NULL
) ENGINE=InnoDB DEFAULT CHARSET=utf8mb4 COLLATE=utf8mb4_unicode_ci;

--
-- Dumping data for table `cdt_role_module_method_rights`
--

INSERT INTO `cdt_role_module_method_rights` (`role_module_method_right_id`, `role_id`, `module_id`, `method_id`, `created_at`, `updated_at`, `deleted_at`) VALUES
(1, 1, 1, 1, '2026-05-01 02:01:41', '2026-05-01 02:01:41', NULL),
(2, 1, 2, 2, '2026-05-01 02:01:41', '2026-05-01 02:01:41', NULL),
(3, 1, 2, 3, '2026-05-01 02:01:41', '2026-05-01 02:01:41', NULL),
(4, 1, 2, 4, '2026-05-01 02:01:41', '2026-05-01 02:01:41', NULL),
(5, 1, 3, 21, '2026-05-01 02:01:41', '2026-05-01 02:01:41', NULL),
(6, 1, 3, 22, '2026-05-01 02:01:41', '2026-05-01 02:01:41', NULL),
(7, 1, 3, 23, '2026-05-01 02:01:41', '2026-05-01 02:01:41', NULL),
(8, 1, 3, 24, '2026-05-01 02:01:41', '2026-05-01 02:01:41', NULL),
(9, 1, 3, 25, '2026-05-01 02:01:41', '2026-05-01 02:01:41', NULL),
(10, 1, 3, 26, '2026-05-01 02:01:41', '2026-05-01 02:01:41', NULL),
(11, 1, 3, 27, '2026-05-01 02:01:41', '2026-05-01 02:01:41', NULL),
(12, 1, 3, 28, '2026-05-01 02:01:41', '2026-05-01 02:01:41', NULL),
(13, 1, 3, 29, '2026-05-01 02:01:41', '2026-05-01 02:01:41', NULL),
(14, 1, 3, 30, '2026-05-01 02:01:41', '2026-05-01 02:01:41', NULL),
(15, 1, 4, 41, '2026-05-01 02:01:41', '2026-05-01 02:01:41', NULL),
(16, 1, 4, 42, '2026-05-01 02:01:41', '2026-05-01 02:01:41', NULL),
(17, 1, 4, 43, '2026-05-01 02:01:41', '2026-05-01 02:01:41', NULL),
(18, 1, 4, 44, '2026-05-01 02:01:41', '2026-05-01 02:01:41', NULL),
(19, 1, 4, 45, '2026-05-01 02:01:41', '2026-05-01 02:01:41', NULL),
(20, 1, 4, 46, '2026-05-01 02:01:41', '2026-05-01 02:01:41', NULL),
(21, 1, 5, 51, '2026-05-01 02:01:41', '2026-05-01 02:01:41', NULL),
(22, 1, 5, 52, '2026-05-01 02:01:41', '2026-05-01 02:01:41', NULL),
(23, 1, 5, 53, '2026-05-01 02:01:41', '2026-05-01 02:01:41', NULL),
(24, 1, 5, 54, '2026-05-01 02:01:41', '2026-05-01 02:01:41', NULL),
(25, 1, 5, 55, '2026-05-01 02:01:41', '2026-05-01 02:01:41', NULL),
(26, 1, 11, 111, '2026-05-01 02:01:41', '2026-05-01 02:01:41', NULL),
(27, 1, 11, 112, '2026-05-01 02:01:41', '2026-05-01 02:01:41', NULL),
(28, 1, 11, 113, '2026-05-01 02:01:41', '2026-05-01 02:01:41', NULL),
(29, 1, 11, 114, '2026-05-01 02:01:41', '2026-05-01 02:01:41', NULL),
(30, 1, 11, 115, '2026-05-01 02:01:41', '2026-05-01 02:01:41', NULL),
(31, 1, 11, 116, '2026-05-01 02:01:41', '2026-05-01 02:01:41', NULL),
(32, 1, 12, 121, '2026-05-01 02:01:41', '2026-05-01 02:01:41', NULL),
(33, 1, 12, 122, '2026-05-01 02:01:41', '2026-05-01 02:01:41', NULL),
(34, 1, 12, 123, '2026-05-01 02:01:41', '2026-05-01 02:01:41', NULL),
(35, 1, 12, 124, '2026-05-01 02:01:41', '2026-05-01 02:01:41', NULL),
(36, 1, 12, 125, '2026-05-01 02:01:41', '2026-05-01 02:01:41', NULL),
(37, 1, 12, 126, '2026-05-01 02:01:41', '2026-05-01 02:01:41', NULL),
(38, 1, 13, 131, '2026-05-01 02:01:41', '2026-05-01 02:01:41', NULL),
(39, 1, 13, 132, '2026-05-01 02:01:41', '2026-05-01 02:01:41', NULL),
(40, 1, 13, 133, '2026-05-01 02:01:41', '2026-05-01 02:01:41', NULL),
(41, 1, 13, 134, '2026-05-01 02:01:41', '2026-05-01 02:01:41', NULL),
(42, 1, 13, 135, '2026-05-01 02:01:41', '2026-05-01 02:01:41', NULL),
(43, 1, 13, 136, '2026-05-01 02:01:41', '2026-05-01 02:01:41', NULL),
(44, 1, 14, 141, '2026-05-01 02:01:41', '2026-05-01 02:01:41', NULL),
(45, 1, 14, 142, '2026-05-01 02:01:41', '2026-05-01 02:01:41', NULL),
(46, 1, 14, 143, '2026-05-01 02:01:41', '2026-05-01 02:01:41', NULL),
(47, 1, 14, 144, '2026-05-01 02:01:41', '2026-05-01 02:01:41', NULL),
(48, 1, 14, 145, '2026-05-01 02:01:41', '2026-05-01 02:01:41', NULL),
(49, 1, 14, 146, '2026-05-01 02:01:41', '2026-05-01 02:01:41', NULL),
(50, 1, 15, 151, '2026-05-01 02:01:41', '2026-05-01 02:01:41', NULL),
(51, 1, 15, 152, '2026-05-01 02:01:41', '2026-05-01 02:01:41', NULL),
(52, 1, 15, 153, '2026-05-01 02:01:41', '2026-05-01 02:01:41', NULL),
(53, 1, 15, 154, '2026-05-01 02:01:41', '2026-05-01 02:01:41', NULL),
(54, 1, 15, 155, '2026-05-01 02:01:41', '2026-05-01 02:01:41', NULL),
(55, 1, 15, 156, '2026-05-01 02:01:41', '2026-05-01 02:01:41', NULL),
(56, 1, 15, 157, '2026-05-01 02:01:41', '2026-05-01 02:01:41', NULL),
(57, 1, 16, 161, '2026-05-01 02:01:41', '2026-05-01 02:01:41', NULL),
(58, 1, 16, 162, '2026-05-01 02:01:41', '2026-05-01 02:01:41', NULL),
(59, 1, 16, 163, '2026-05-01 02:01:41', '2026-05-01 02:01:41', NULL),
(60, 1, 16, 164, '2026-05-01 02:01:41', '2026-05-01 02:01:41', NULL),
(61, 1, 56, 561, '2026-05-01 02:01:41', '2026-05-01 02:01:41', NULL),
(62, 1, 56, 562, '2026-05-01 02:01:41', '2026-05-01 02:01:41', NULL),
(63, 1, 56, 563, '2026-05-01 02:01:41', '2026-05-01 02:01:41', NULL),
(64, 1, 56, 564, '2026-05-01 02:01:41', '2026-05-01 02:01:41', NULL),
(65, 1, 56, 565, '2026-05-01 02:01:41', '2026-05-01 02:01:41', NULL),
(66, 1, 56, 566, '2026-05-01 02:01:41', '2026-05-01 02:01:41', NULL),
(67, 1, 56, 567, '2026-05-01 02:01:41', '2026-05-01 02:01:41', NULL),
(68, 1, 59, 591, '2026-05-01 02:01:41', '2026-05-01 02:01:41', NULL),
(69, 1, 59, 592, '2026-05-01 02:01:41', '2026-05-01 02:01:41', NULL),
(70, 1, 59, 593, '2026-05-01 02:01:41', '2026-05-01 02:01:41', NULL),
(71, 1, 59, 594, '2026-05-01 02:01:41', '2026-05-01 02:01:41', NULL);

-- --------------------------------------------------------

--
-- Table structure for table `cdt_seo_meta`
--

CREATE TABLE `cdt_seo_meta` (
  `id` bigint UNSIGNED NOT NULL,
  `seoable_type` varchar(255) COLLATE utf8mb4_unicode_ci NOT NULL,
  `seoable_id` bigint UNSIGNED NOT NULL,
  `meta_title` varchar(500) COLLATE utf8mb4_unicode_ci DEFAULT NULL,
  `meta_description` text COLLATE utf8mb4_unicode_ci,
  `meta_keywords` varchar(500) COLLATE utf8mb4_unicode_ci DEFAULT NULL,
  `og_title` varchar(255) COLLATE utf8mb4_unicode_ci DEFAULT NULL,
  `og_description` text COLLATE utf8mb4_unicode_ci,
  `og_image` varchar(512) COLLATE utf8mb4_unicode_ci DEFAULT NULL,
  `canonical_url` varchar(512) COLLATE utf8mb4_unicode_ci DEFAULT NULL,
  `noindex` tinyint(1) NOT NULL DEFAULT '0',
  `nofollow` tinyint(1) NOT NULL DEFAULT '0',
  `structured_data` json DEFAULT NULL,
  `created_id` int NOT NULL DEFAULT '0',
  `updated_id` int NOT NULL DEFAULT '0',
  `created_at` timestamp NULL DEFAULT NULL,
  `updated_at` timestamp NULL DEFAULT NULL
) ENGINE=InnoDB DEFAULT CHARSET=utf8mb4 COLLATE=utf8mb4_unicode_ci;

--
-- Dumping data for table `cdt_seo_meta`
--

INSERT INTO `cdt_seo_meta` (`id`, `seoable_type`, `seoable_id`, `meta_title`, `meta_description`, `meta_keywords`, `og_title`, `og_description`, `og_image`, `canonical_url`, `noindex`, `nofollow`, `structured_data`, `created_id`, `updated_id`, `created_at`, `updated_at`) VALUES
(1, 'Page', 1, 'Chagger Dental | The Clinical Sanctuary', NULL, NULL, NULL, NULL, NULL, NULL, 0, 0, NULL, 1, 1, '2026-05-01 02:24:30', '2026-05-01 02:24:30');





-- --------------------------------------------------------

--
-- Table structure for table `cdt_template`
--

CREATE TABLE `cdt_template` (
  `template_id` int UNSIGNED NOT NULL,
  `name` varchar(128) COLLATE utf8mb4_unicode_ci NOT NULL,
  `blade_file` varchar(128) COLLATE utf8mb4_unicode_ci NOT NULL,
  `route_path` varchar(255) COLLATE utf8mb4_unicode_ci NOT NULL,
  `controller_name` varchar(255) COLLATE utf8mb4_unicode_ci NOT NULL,
  `controller_logic` varchar(128) COLLATE utf8mb4_unicode_ci NOT NULL,
  `module_id` int NOT NULL,
  `device_type` enum('web','api','app') COLLATE utf8mb4_unicode_ci NOT NULL DEFAULT 'web',
  `status` enum('enabled','disabled') COLLATE utf8mb4_unicode_ci NOT NULL DEFAULT 'enabled',
  `created_id` int NOT NULL DEFAULT '0',
  `updated_id` int NOT NULL DEFAULT '0',
  `created_at` timestamp NULL DEFAULT NULL,
  `updated_at` timestamp NULL DEFAULT NULL
) ENGINE=InnoDB DEFAULT CHARSET=utf8mb4 COLLATE=utf8mb4_unicode_ci;

--
-- Dumping data for table `cdt_template`
--

INSERT INTO `cdt_template` (`template_id`, `name`, `blade_file`, `route_path`, `controller_name`, `controller_logic`, `module_id`, `device_type`, `status`, `created_id`, `updated_id`, `created_at`, `updated_at`) VALUES
(1, 'Home Template', 'index', '/', 'WebEnquiryController', 'render', 15, 'web', 'enabled', 1, 1, '2026-05-01 02:23:03', '2026-05-01 08:48:38'),
(2, 'Thank You Template', 'thank-you', 'thank-you/{slug}', 'WebPageController', 'thankYouData', 15, 'web', 'enabled', 1, 1, '2026-05-01 11:23:00', '2026-05-01 11:23:00'),
(3, 'Services Template', 'services', 'services', 'WebPageController', 'servicesData', 15, 'web', 'enabled', 1, 1, '2026-05-01 13:30:56', '2026-05-01 13:30:56'),
(4, 'Service Detail Template', 'service', 'service/{slug}', 'WebEnquiryController', 'serviceData', 15, 'web', 'enabled', 1, 1, '2026-05-01 13:32:50', '2026-05-02 02:00:35'),
(5, 'Book Appointment Template', 'book-appointment', 'book-appointment', 'WebEnquiryController', 'bookAppointment', 15, 'web', 'enabled', 1, 1, '2026-05-02 02:41:55', '2026-05-02 02:41:55'),
(6, 'About Us Template', 'about', 'about', 'WebPageController', 'aboutData', 15, 'web', 'enabled', 1, 1, '2026-05-02 07:48:07', '2026-05-02 07:48:07'),
(7, 'Locations Template', 'locations', 'locations', 'WebEnquiryController', 'locationsData', 15, 'web', 'enabled', 1, 1, '2026-05-02 08:03:26', '2026-05-02 08:40:06'),
(8, 'Location Detail Template', 'location', 'location/{slug}', 'WebEnquiryController', 'locationData', 15, 'web', 'enabled', 1, 1, '2026-05-02 08:10:28', '2026-05-02 08:40:17'),
(9, 'Reviews Template', 'reviews', 'reviews', 'WebPageController', 'reviewsData', 15, 'web', 'enabled', 1, 1, '2026-05-02 08:11:17', '2026-05-02 08:11:17'),
(10, 'Oakville Dentist Template', 'oakville-dentist', 'oakville-dentist', 'WebEnquiryController', 'oakvilleDentist', 15, 'web', 'enabled', 1, 1, '2026-05-08 23:29:14', '2026-05-08 23:50:34'),
(11, 'Burlington Dentist Template', 'burlington-dentist', 'burlington-dentist', 'WebEnquiryController', 'burlingtonDentist', 15, 'web', 'enabled', 1, 1, '2026-05-08 23:30:36', '2026-05-08 23:50:40'),
(12, 'Mississauga Dentist Template', 'mississauga-dentist', 'mississauga-dentist', 'WebEnquiryController', 'mississaugaDentist', 15, 'web', 'enabled', 1, 1, '2026-05-08 23:31:31', '2026-05-08 23:50:46'),
(13, 'New Patient Form Template', 'new-patient-form', 'new-patient-form/{locationSlug?}', 'WebEnquiryController', 'newPatientForm', 15, 'web', 'enabled', 1, 1, '2026-05-13 09:33:34', '2026-05-13 09:40:40');

--
-- Indexes for table `cdt_admin_access_logs`
--
ALTER TABLE `cdt_admin_access_logs`
  ADD PRIMARY KEY (`id`),
  ADD KEY `cdt_admin_access_logs_admin_id_index` (`admin_id`),
  ADD KEY `cdt_admin_access_logs_role_id_index` (`role_id`),
  ADD KEY `cdt_admin_access_logs_username_index` (`username`),
  ADD KEY `cdt_admin_access_logs_ip_address_index` (`ip_address`),
  ADD KEY `cdt_admin_access_logs_accessed_at_index` (`accessed_at`);

--
-- Indexes for table `cdt_admin_role`
--
ALTER TABLE `cdt_admin_role`
  ADD PRIMARY KEY (`role_id`),
  ADD UNIQUE KEY `cdt_admin_role_title_unique` (`title`);

--
-- Indexes for table `cdt_clinics`
--
ALTER TABLE `cdt_clinics`
  ADD PRIMARY KEY (`clinic_id`),
  ADD UNIQUE KEY `cdt_clinics_slug_unique` (`slug`);

--
-- Indexes for table `cdt_custom_field`
--
ALTER TABLE `cdt_custom_field`
  ADD PRIMARY KEY (`custom_field_id`),
  ADD UNIQUE KEY `unq_fn_t` (`field_name`,`type`);

--
-- Indexes for table `cdt_custom_field_group`
--
ALTER TABLE `cdt_custom_field_group`
  ADD PRIMARY KEY (`cf_group_id`);

--
-- Indexes for table `cdt_custom_field_group_custom_field`
--
ALTER TABLE `cdt_custom_field_group_custom_field`
  ADD PRIMARY KEY (`cfgc_field_id`),
  ADD UNIQUE KEY `cfg_cf_id` (`cf_group_id`,`custom_field_id`);

--
-- Indexes for table `cdt_custom_field_group_template`
--
ALTER TABLE `cdt_custom_field_group_template`
  ADD PRIMARY KEY (`cfg_template_id`),
  ADD UNIQUE KEY `cfg_t_id` (`cf_group_id`,`template_id`);

--
-- Indexes for table `cdt_custom_field_value`
--
ALTER TABLE `cdt_custom_field_value`
  ADD PRIMARY KEY (`cf_value_id`);

--
-- Indexes for table `cdt_email_template`
--
ALTER TABLE `cdt_email_template`
  ADD PRIMARY KEY (`et_id`);

--
-- Indexes for table `cdt_failed_jobs`
--
ALTER TABLE `cdt_failed_jobs`
  ADD PRIMARY KEY (`id`),
  ADD UNIQUE KEY `cdt_failed_jobs_uuid_unique` (`uuid`);

--
-- Indexes for table `cdt_forms`
--
ALTER TABLE `cdt_forms`
  ADD PRIMARY KEY (`id`),
  ADD UNIQUE KEY `cdt_forms_form_slug_unique` (`form_slug`),
  ADD KEY `cdt_forms_form_slug_index` (`form_slug`),
  ADD KEY `cdt_forms_status_index` (`status`);

--
-- Indexes for table `cdt_form_fields`
--
ALTER TABLE `cdt_form_fields`
  ADD PRIMARY KEY (`id`),
  ADD KEY `cdt_form_fields_field_name_index` (`field_name`),
  ADD KEY `cdt_form_fields_status_index` (`status`),
  ADD KEY `cdt_form_fields_form_id_order_index` (`form_id`,`order`);

--
-- Indexes for table `cdt_form_submissions`
--
ALTER TABLE `cdt_form_submissions`
  ADD PRIMARY KEY (`id`),
  ADD KEY `cdt_form_submissions_form_id_index` (`form_id`),
  ADD KEY `cdt_form_submissions_status_index` (`status`);

--
-- Indexes for table `cdt_form_submission_values`
--
ALTER TABLE `cdt_form_submission_values`
  ADD PRIMARY KEY (`id`),
  ADD KEY `cdt_form_submission_values_field_name_index` (`field_name`),
  ADD KEY `cdt_form_submission_values_submission_id_field_name_index` (`submission_id`,`field_name`);

--
-- Indexes for table `cdt_migrations`
--
ALTER TABLE `cdt_migrations`
  ADD PRIMARY KEY (`id`);

--
-- Indexes for table `cdt_modules`
--
ALTER TABLE `cdt_modules`
  ADD PRIMARY KEY (`module_id`),
  ADD UNIQUE KEY `cdt_modules_title_class_name_unique` (`title`,`class_name`);

--
-- Indexes for table `cdt_module_class`
--
ALTER TABLE `cdt_module_class`
  ADD PRIMARY KEY (`class_id`),
  ADD UNIQUE KEY `cdt_module_class_class_name_unique` (`class_name`),
  ADD UNIQUE KEY `cdt_module_class_slug_unique` (`slug`);

--
-- Indexes for table `cdt_module_methods`
--
ALTER TABLE `cdt_module_methods`
  ADD PRIMARY KEY (`method_id`);

--
-- Indexes for table `cdt_page`
--
ALTER TABLE `cdt_page`
  ADD PRIMARY KEY (`page_id`),
  ADD UNIQUE KEY `cdt_page_slug_unique` (`slug`);

--
-- Indexes for table `cdt_password_reset_tokens`
--
ALTER TABLE `cdt_password_reset_tokens`
  ADD PRIMARY KEY (`email`);

--
-- Indexes for table `cdt_personal_access_tokens`
--
ALTER TABLE `cdt_personal_access_tokens`
  ADD PRIMARY KEY (`id`),
  ADD UNIQUE KEY `cdt_personal_access_tokens_token_unique` (`token`),
  ADD KEY `cdt_personal_access_tokens_tokenable_type_tokenable_id_index` (`tokenable_type`,`tokenable_id`);

--
-- Indexes for table `cdt_role_module_method_rights`
--
ALTER TABLE `cdt_role_module_method_rights`
  ADD PRIMARY KEY (`role_module_method_right_id`),
  ADD UNIQUE KEY `r_m_m_id` (`role_id`,`module_id`,`method_id`);

--
-- Indexes for table `cdt_seo_meta`
--
ALTER TABLE `cdt_seo_meta`
  ADD PRIMARY KEY (`id`),
  ADD KEY `cdt_seo_meta_seoable_type_seoable_id_index` (`seoable_type`,`seoable_id`);

--
-- Indexes for table `cdt_settings`
--
ALTER TABLE `cdt_settings`
  ADD PRIMARY KEY (`stng_id`);

--
-- Indexes for table `cdt_template`
--
ALTER TABLE `cdt_template`
  ADD PRIMARY KEY (`template_id`),
  ADD UNIQUE KEY `unq_dt_rp` (`device_type`,`route_path`),
  ADD UNIQUE KEY `unq_cn_cl` (`controller_name`,`controller_logic`);

--
-- AUTO_INCREMENT for table `cdt_admin_access_logs`
--
ALTER TABLE `cdt_admin_access_logs`
  MODIFY `id` bigint UNSIGNED NOT NULL AUTO_INCREMENT;

--
-- AUTO_INCREMENT for table `cdt_admin_role`
--
ALTER TABLE `cdt_admin_role`
  MODIFY `role_id` int UNSIGNED NOT NULL AUTO_INCREMENT, AUTO_INCREMENT=2;

--
-- AUTO_INCREMENT for table `cdt_clinics`
--
ALTER TABLE `cdt_clinics`
  MODIFY `clinic_id` int UNSIGNED NOT NULL AUTO_INCREMENT, AUTO_INCREMENT=4;

--
-- AUTO_INCREMENT for table `cdt_custom_field`
--
ALTER TABLE `cdt_custom_field`
  MODIFY `custom_field_id` int UNSIGNED NOT NULL AUTO_INCREMENT;

--
-- AUTO_INCREMENT for table `cdt_custom_field_group`
--
ALTER TABLE `cdt_custom_field_group`
  MODIFY `cf_group_id` int UNSIGNED NOT NULL AUTO_INCREMENT;

--
-- AUTO_INCREMENT for table `cdt_custom_field_group_custom_field`
--
ALTER TABLE `cdt_custom_field_group_custom_field`
  MODIFY `cfgc_field_id` bigint UNSIGNED NOT NULL AUTO_INCREMENT;

--
-- AUTO_INCREMENT for table `cdt_custom_field_group_template`
--
ALTER TABLE `cdt_custom_field_group_template`
  MODIFY `cfg_template_id` bigint UNSIGNED NOT NULL AUTO_INCREMENT;

--
-- AUTO_INCREMENT for table `cdt_custom_field_value`
--
ALTER TABLE `cdt_custom_field_value`
  MODIFY `cf_value_id` bigint UNSIGNED NOT NULL AUTO_INCREMENT;

--
-- AUTO_INCREMENT for table `cdt_email_template`
--
ALTER TABLE `cdt_email_template`
  MODIFY `et_id` int UNSIGNED NOT NULL AUTO_INCREMENT, AUTO_INCREMENT=10;

--
-- AUTO_INCREMENT for table `cdt_failed_jobs`
--
ALTER TABLE `cdt_failed_jobs`
  MODIFY `id` bigint UNSIGNED NOT NULL AUTO_INCREMENT;

--
-- AUTO_INCREMENT for table `cdt_forms`
--
ALTER TABLE `cdt_forms`
  MODIFY `id` bigint UNSIGNED NOT NULL AUTO_INCREMENT, AUTO_INCREMENT=5;

--
-- AUTO_INCREMENT for table `cdt_form_fields`
--
ALTER TABLE `cdt_form_fields`
  MODIFY `id` bigint UNSIGNED NOT NULL AUTO_INCREMENT, AUTO_INCREMENT=120;

--
-- AUTO_INCREMENT for table `cdt_form_submissions`
--
ALTER TABLE `cdt_form_submissions`
  MODIFY `id` bigint UNSIGNED NOT NULL AUTO_INCREMENT, AUTO_INCREMENT=42;

--
-- AUTO_INCREMENT for table `cdt_form_submission_values`
--
ALTER TABLE `cdt_form_submission_values`
  MODIFY `id` bigint UNSIGNED NOT NULL AUTO_INCREMENT, AUTO_INCREMENT=2677;

--
-- AUTO_INCREMENT for table `cdt_migrations`
--
ALTER TABLE `cdt_migrations`
  MODIFY `id` int UNSIGNED NOT NULL AUTO_INCREMENT, AUTO_INCREMENT=26;

--
-- AUTO_INCREMENT for table `cdt_modules`
--
ALTER TABLE `cdt_modules`
  MODIFY `module_id` int UNSIGNED NOT NULL AUTO_INCREMENT, AUTO_INCREMENT=60;

--
-- AUTO_INCREMENT for table `cdt_module_class`
--
ALTER TABLE `cdt_module_class`
  MODIFY `class_id` int UNSIGNED NOT NULL AUTO_INCREMENT, AUTO_INCREMENT=60;

--
-- AUTO_INCREMENT for table `cdt_module_methods`
--
ALTER TABLE `cdt_module_methods`
  MODIFY `method_id` int UNSIGNED NOT NULL AUTO_INCREMENT, AUTO_INCREMENT=595;

--
-- AUTO_INCREMENT for table `cdt_page`
--
ALTER TABLE `cdt_page`
  MODIFY `page_id` int UNSIGNED NOT NULL AUTO_INCREMENT, AUTO_INCREMENT=34;

--
-- AUTO_INCREMENT for table `cdt_personal_access_tokens`
--
ALTER TABLE `cdt_personal_access_tokens`
  MODIFY `id` bigint UNSIGNED NOT NULL AUTO_INCREMENT;

--
-- AUTO_INCREMENT for table `cdt_role_module_method_rights`
--
ALTER TABLE `cdt_role_module_method_rights`
  MODIFY `role_module_method_right_id` int UNSIGNED NOT NULL AUTO_INCREMENT, AUTO_INCREMENT=72;

--
-- AUTO_INCREMENT for table `cdt_seo_meta`
--
ALTER TABLE `cdt_seo_meta`
  MODIFY `id` bigint UNSIGNED NOT NULL AUTO_INCREMENT, AUTO_INCREMENT=2;

--
-- AUTO_INCREMENT for table `cdt_settings`
--
ALTER TABLE `cdt_settings`
  MODIFY `stng_id` int UNSIGNED NOT NULL AUTO_INCREMENT, AUTO_INCREMENT=32;

--
-- AUTO_INCREMENT for table `cdt_template`
--
ALTER TABLE `cdt_template`
  MODIFY `template_id` int UNSIGNED NOT NULL AUTO_INCREMENT, AUTO_INCREMENT=14;
COMMIT;

