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Form for inspection completed
Guide for the edentulous patient
1. Information about the doctor
Name:
Mob. Tel. No.:
E-mail:
2. Clinical case details
Patient's name, surname or other personal identification code:
Implants are planned:
Comment:
Provisional position of implant(s) according to FDI numbering
During the operation, it is also planned to:
Comment:
3. Dental implant system
Comment:
4. Surgical guide type
Selected
Pilot graft diameter
For evaluation and approval of the guided implant surgery plan:*
Selected
5. Providing information for planning
File:
6. I would like to order
Selected
Comment:
7. Information
Date of the operation:
Clinic name:
Shipping address: