Form to fill out
Date*
To make an appointment Contact the patientThe patient will contact you
Birth date*
Reason for consultation ScanLower jawUpper jawRadiological guideSimplant evaluationImplantSinus lift elevationBone graftSoft tissue graft (Alloderm, Gingival, Connective)Hyperplastic tissues removalSurgical extractionDental crown-lengthening
Planned prosthesis implants Number of implants12345 ou 12
Position
Attachments
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Remarks