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Referring Doctor
Referring Doctor Phone
This is to introduce to your office for endodontic examination of tooth/teeth numbers:
Patient Phone:
Periapical Radioluscency
YesNo
Elective Endodontics
Post/File Removal
Pulp Exposure - Please Treat
Extraction with socket preservation
Retreat Existing RCT
Place Core Upon Completion of RCT
Tooth Accessed - Please Treat
Others
Notes:
Δ
