Treatment Submission

Treatment Submissions
Patient Name
Patient Name
Treatment
Laser Procedure? (select all that apply)
Number of teeth to be restored?
Arches needing retainer replacement?
Arches needing relapse aligners?
Scan complete?
Timing
Has treatment recommendation been discussed with parent? (not necessary if in tx plan)
Has treatment recommendation been discussed with parent?

Address

31560 Rancho Pueblo Road Suite 201
Temecula, CA, 92592

Text

951-457-6798

Call

951-302-0685
Scroll to Top