Reasons For Referral *

Comprehensive Orthodontic Treatment Evaluation

Clear Aligner Therapy/Invisalign

Clear Braces

Early Inceptive Treatment

Lingual Braces

Space Maintenance

Habit Correction

Pre-Prosthetic/Implant Site Development

Crowding

Spacing

Overjet

Deep Bite

Crossbite

Missing Tooth

Impacted Teeth

Open Bite

Other

Relevant Dental History

Restorative Treatment

Is Completed

Is Underway

Is Pending Outcome of Orthodontic Findings

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File Upload - X-Rays, Radiographs and Other Files

Next Prophy/Evaluation Appointment

Comments

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