PATIENT DETAILS

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    APPOINTMENT INFORMATION

    PROSTHODONTICS: Dental treatment as you see fitTreatment for tooth/teeth onlyDiagnosis and opinion only

    DENTAL IMPLANTS: Dental implant management & restorationManagement of implant complications

    Please select from the Dental implant management & restoration options: Implant/s placed, please restoreReferrer to select implant surgeon (please specify)adelaideCAD to place implant or select implant surgeon

    TMD: Temporomandibular joint disorder

    Please select from the TMD options: Pain on masticatory muscle or jointBruxism / ClenchingClicking / Crepitus +/- Disc Displacement with or without reduction

    ADDITIONAL DETAILS:


    YOUR CONTACT DETAILS

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