Privat Practice specialized in Oral Surgery, Implantology and Periodontology
REQUESTED SHEET
FOR DIGITAL
VOLUME TOMOGRAPHY

 
Patient´s details
 
 
 
 


Clinical related questions
scheduled operations
 


Demands for scan
 
Picture of jaw / Stent.
 
The record will be needed for import in a navigation program:
Following program will be used:  

Data of referral