Invisinet Quick Assessment Dentist’s Name: Patient’s First Name: Date:

Invisinet Quick Assessment Patient’s Concerns: Oral Health Assessment Perio risk: Low Med High (delete as reqd) Caries risk: Low Med High (delete as reqd) TMJ dysfunction: No symptoms or signs Signs but no symptoms Symptoms (delete as reqd) Compliance: Low Med High (delete as reqd) Your Provisional Treatment Plan:

Extra Oral Front Repose

Extra Oral Front Smiling

Extra Oral Right Lateral View

Extra Oral Left Lateral View

Extra Oral Profile

Right Lateral Smile

Frontal Smile

Left Lateral Smile

Intra Oral Anterior

Intra Oral Right Buccal

Intra Oral Left Buccal

Intra Oral Upper Occlusal

Intra Oral Lower Occlusal