Patient Portal

JITADC PATIENT PORTAL

Your dental care, made simpler.

Consult with us online, prepare for your clinic visit, complete your patient forms or securely manage the next step in your care.

Choose what you need

How can we help you today?

Choose an option and we’ll only show you the information relevant to what you want to do.

ONLINE CARE

Online Dental Consultation

Speak with a JITADC dental professional remotely and securely share relevant information before your consultation.

Start an online consultation →

IN-CLINIC CARE

Visiting the Clinic

Prepare for your visit, register as a new patient and complete the information we need before you are seen.

Prepare for my visit →

PATIENT FORMS

Prepare Patient Forms

Fill the patient forms on this device and save a printable copy, or download blank PDFs to complete by hand.

Prepare your forms →

Download Forms

Prefer paper? Download the forms you need and complete them before your visit.

View downloadable forms →

Send X-rays or Images

Securely provide relevant X-rays, intraoral images or reports when requested by your dentist.

How to send images →

Make a Payment

Choose how you would like to pay: start an online consultation, or ask the clinic for a payment request for a proforma invoice or deposit.

Go to payments →

ONLINE DENTAL CONSULTATION

Get professional dental guidance wherever you are.

Tell us what you need help with, choose your consultation option and secure it before completing the more detailed patient and clinical information.

Enter the email you want linked to your consultation
Pay the fixed KES 2,000 consultation fee securely
Choose M-Pesa, Airtel Money, card or another available method on Pesapal
Then complete registration, privacy and clinical information
Upload X-rays or dental images if relevant

Start your online consultation

We only ask for the basics at this stage. Detailed patient and clinical information comes after your consultation is secured.

Full name WhatsApp / mobile number Email address Have you visited JITADC before?

What would you like help with? Briefly tell us what is happening

Your consultation is secured only after verified payment confirmation. Detailed registration and clinical information comes next.

Designed for a smooth start

Payment happens early in the online-consultation journey so you can secure the consultation without completing a long clinical questionnaire first.

Once payment is confirmed, your clinical information remains within the JITADC patient workflow rather than becoming part of the payment processor record.

New patient registration

This mirrors the information on the JITADC paper registration form, with a simpler online experience.

About you Who may we thank for referring you?

Full name Date of birth Postal address Postal code Occupation Email address Phone number Residence

Person responsible for account Same as patient

Full name Date of birth Relationship to patient Postal address Postal code Email address Phone number

Dental insurance / corporate scheme

Will you be using insurance or an approved corporate scheme for this visit?

Yes No

After payment confirmation, complete your consultation details and submit them securely to the clinic.

Visiting JITADC?

Save time at reception: fill your forms on this device and save or print them, or download blank forms to complete by hand. Bring your completed forms to your appointment.

1. Patient Registration

Personal and contact details, account responsibility, insurance information and referral source.

2. Privacy & Data Protection

Read our website privacy page to learn how your information is used and what rights you have.

3. Optional Marketing Consent

If you wish to receive marketing messages, you may complete the optional marketing consent form. Your care does not depend on it.

View patient forms

Prepare your patient forms

Choose whether to fill the patient forms on this device and save or print them, or download blank PDFs. Bring your completed forms to your appointment. Answers entered here are not sent to the clinic; our privacy page explains how we handle information you give us.

Choose how to prepare your forms

Fill them on this device and save or print a completed copy, or download blank PDFs to fill by hand. Forms completed on this device are not sent to the clinic. Bring your completed copies to your appointment.

Fill and save forms →Download blank forms →

Fill patient forms on this device

Your answers stay in this browser while this page is open. Use “Print / Save as PDF” when finished and bring the completed forms to the clinic. Closing or refreshing the page may erase your answers.

New Patient Information

We are committed to excellence in dentistry and appreciate you taking time to complete this confidential questionnaire. The better we communicate, the better we can care for you. If you have any questions or need assistance, please ask us – we will be happy to help.

Whom may we thank for referring you?

About you

Name * Birth Date * Postal Address Postal Code Occupation Email Address Phone Number * Residence

Person responsible for account

Same as above

Name Birth Date Postal Address Postal Code Relationship Email Address Phone Number

Dental insurance information, if applicable

Insurance Co. Name Phone Insured’s Name Insured’s Birth Date Insured’s Member Number Insured’s Scheme

I confirm that the above information is correct and will agree on all treatment given to me. I will have understood all the explanation given and will have learnt of likely complications from management. I agree to pay all fees required of me.

As part of our smile-keeping routine, our dentist might snap a few intraoral pics during your visit for records and consultations – just a friendly heads-up!

Patient’s / Parent’s / Guardian’s Signature *Date *

Type your name for identification; sign the printed copy by hand before giving it to the clinic.

“But I, when I Am lifted up from the earth, will draw all Men to myself.” (John 12:32)

Patient Consent Form for Imaging and Records

Purpose: To obtain your consent for capturing, storing, and using dental images (e.g., X-rays, intraoral photographs) and treatment records for the following purposes:

Diagnosis and treatment planning
Ongoing medical records
Specialist consultations (where needed)
Regulatory compliance and legal requirements

Your Rights:

Your images and records will be kept confidential and secure.
You may request access to your images.
You may withdraw your consent at any time, subject to legal and professional obligations.

Consent: I hereby consent to the collection, storage, and use of my dental images and records as outlined above.

I consent to the imaging and records purposes above.

Patient Full Name (if consenting)File Number / ID (if available)Signature (if consenting)Date (if consenting)Witness (Clinic Staff)Designation / Signature

The clinic staff witness and signature are completed at the clinic. Sign your printed copy by hand.

Marketing Consent Form (optional)

Purpose: We occasionally send patients updates about services, special offers, seasons’ greetings and oral health tips.

Please indicate your preference below:

YES, I consent to receiving marketing communications via:

SMS Email WhatsApp

NO, I do not wish to receive any marketing communications.

You can withdraw your consent at any time by contacting us via email, phone, or at the clinic reception.

Patient NameContact NumberEmail AddressSignatureDate

Marketing is optional. Leaving this section unselected gives no marketing consent.

This does not submit your answers online. Check the printed or saved copy before bringing it in.

Downloadable patient forms

Download and print the forms you need, complete them by hand, and bring them to your appointment. The marketing form is optional.

X-rays, intraoral images & documents

When your dentist requests X-rays, intraoral images or reports, request a private upload link below. Enter your email address, open the verification email within 20 minutes, and press the confirmation button. We will then email a one-use upload link to that address. It accepts up to four JPG, PNG or PDF files of up to 25 MB each and expires after seven days. Our team will review your submission before filing relevant images in your clinical record; temporary website copies are removed after 30 days. For a large CBCT study, contact the clinic for separate secure transfer instructions. If you cannot access email, contact the clinic for help. Do not send clinical files through the general contact form. Sharing images for your care does not give permission to use them for marketing.

Request a secure upload link →

Payment options for your visit

Choose what you are paying for. For an online consultation, enter your details and use the existing Pesapal checkout for the listed fee. For a proforma invoice or deposit, request a bill-specific Pesapal invoice or use the clinic’s M-PESA Buy Goods Till after confirming the amount with us. For Pesapal, the clinic will confirm the amount and reference, then email an invoice for the full amount due or the agreed deposit. Any remaining balance can be invoiced separately. Do not include X-rays or medical details in a payment reference.

NEW ONLINE CONSULTATION

Start an online consultation

The online consultation is listed at KES 2,000. Enter your details, then use the existing Pesapal checkout to select an available payment method. Go to online consultation →

Consultations use the checkout above; for an invoice or deposit, request a bill-specific Pesapal invoice from the clinic.

EXISTING INVOICE OR DEPOSIT

Pay an existing bill

Already have a proforma invoice or deposit due? Open the Pesapal invoice emailed to you by JITADC and use its payment option. If you have not received one, tap below and include your proforma reference in the message. We will confirm whether you are paying the full balance or an agreed deposit, then email a Pesapal invoice for the amount due now.
Request a Pesapal invoice →

Consultations use the checkout above; for an invoice or deposit, request a bill-specific Pesapal invoice from the clinic.

M-PESA BUY GOODS

Pay by Till

822174

Recipient: Jesus Is The Answer Dental Clinic

Confirm M-PESA displays this recipient name before you pay.

Another way to pay the clinic

For an existing clinic bill or agreed deposit, first confirm the amount and invoice reference with JITADC. In M-PESA, choose Lipa na M-PESA → Buy Goods and Services, then enter Till 822174.

Send us the M-PESA transaction code, amount and invoice reference. We will check the payment in Kopo Kopo before marking your bill paid. Please do not include medical details in the payment message.

Confirm the amount and recipient with JITADC before paying. Your booking or invoice is marked paid only after the clinic verifies the transaction.

Book an Appointment

Request payment instructions

Your privacy matters. JITADC will only collect the information needed for the relevant purpose, and marketing preferences will remain separate from the information required to provide dental care.