Pre-submission Worksheet

This is an optional worksheet for collecting the patient's information for case submission while chairside. This will include:

• Patient's basic information
• Patient's existing condition

1. Chief complaint
2. Midline, Canine & Molar Relationships

• Instructions - 

1. Maintain, improve or idealize existing dental conditions
2. Treatment techniques: IPR, Engagers, Procline, Expand, etc.
3. Additional instructions