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Doctor Referral

Doctor Information

Patient Information

This patient is being referred for evaluation for the following:

Aesthetic Emergency
Fractured Fixed Partial Denture (Bridge)
Maryland Bridge
Match Single Central or other Anterior
Tooth Wear with Broken Restorations

Complex Prosthodontic Care:

Removable Prosthodontics
Complete Denture
Immediate/Interim Denture
Partial Denture


Implant Prosthodontics
Single Tooth Implant
Multiple Tooth Implants
Implant Supported Dentures

Please call me before proceeding with treatment.
I have sent radiographs for your evaluation.
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