Case Evaluation

case evaluation

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Doctor *

Pt. Last Name or ID *

Invoice # *

Metal Margins *

Excellent Over-Extended Short Unacceptable

Porcelain Margins *

Excellent Good Fair Unacceptable

Contour *

Excellent Good Fair Unacceptable

Contacts *

Perfect Minimal Adjustment Heavy Adjustment Missing

Occlusion *

Perfect Minimal Adjustment Heavy Adjustmet Missing

Shade *

Excellent Good Fair Unacceptable

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Please contact me regarding this case This case is being returned to ADT

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