1. Your Name Here, DDS/DMD Month 30, 2013

2. Patient’s Chief Complaint

3. Medical History

4. Dental History (chronologically how they’ve gotten to this point)

5. Medications

6. Preexisting Implant Information (type, size, when they were placed)

7. Diagnosis Perio: Dentition: TMD/MFP:

8. Diagnostic Notes

9. Patient Photos Full face smilingFull face profile

10. Patient Photos Close up smileClose up profile Patient Photos

11. Tipped down smileRest position Patient Photos

12. Retracted - teeth apartRetracted - MI Patient Photos

13. Upper occlusalLower occlusal Patient Photos

14. CBCT Scan

15. X-rays

17. Panograph

18. Patient Chart

19. Tentative Treatment Plan