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

2. 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:

3. Extra Oral Front Repose

4. Extra Oral Front Smiling

5. Extra Oral Right Lateral View

6. Extra Oral Left Lateral View

7. Extra Oral Profile

8. Right Lateral Smile

9. Frontal Smile

10. Left Lateral Smile

11. Intra Oral Anterior

12. Intra Oral Right Buccal

13. Intra Oral Left Buccal

14. Intra Oral Upper Occlusal

15. Intra Oral Lower Occlusal