New Patient Treatment Parameters
Date:
__________________
Patient:
________________________________________
Maxilla Mandible
Proposed
Prosthetic Treatment: __________________________________________
Implant
Placement: ___________________________________________________
Interim
Restoration: ___________________________________________________
Extractions:
_________________________________________________________
Bone
Grafting: _______________________________________________________
Soft
Tissue Grafting: __________________________________________________
Stent:
______________________________________________________________
Date
Scheduled for this office _____________________ for ____________________
_____________________
______________________________________________
Please
call if you have any questions about your patient=s treatment.