Your Name Here, DDS/DMD Month 30, 2013
Patient’s Chief Complaint
Medical History
Dental History (chronologically how they’ve gotten to this point)
Medications
Preexisting Implant Information (type, size, when they were placed)
Diagnosis Perio: Dentition: TMD/MFP:
Diagnostic Notes
Patient Photos Full face smilingFull face profile
Patient Photos Close up smileClose up profile Patient Photos
Tipped down smileRest position Patient Photos
Retracted - teeth apartRetracted - MI Patient Photos
Upper occlusalLower occlusal Patient Photos
CBCT Scan
X-rays
Panograph
Patient Chart
Tentative Treatment Plan