Doctor Referral All fields marked with an asterisk (*) are required. Introducing: Evaluation Type General Assessment Specific Area Soft Tissue Graft Crown Lengthening 4½ Month Alternate Cleaning Pathology Implant Surgery IV Sedation Please upload any Panograph, Peri-apical, Bitewing, and CBCT for the patient: Please indicate the date when the images were obtained: Please upload any other photos of the patient: Other Assessments / Comments Press the submit button once to submit the form. You will receive a confirmation, after any images have been uploaded.
