info@wisdomteethandimplants.com.au
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Patient Details
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Referrer Details
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Indication
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Complicated tooth Extraction
Widsom teeth Extraction
Ectopic/ supernumerary/ Impacted Teeth
Pathology
Preprosthetic
Implants including full arch rehabilitation (All on 4)
Other
Mouth Top left
8
7
6
5
4
3
2
1
Mouth Top Right
1
2
3
4
5
6
7
8
Mouth Bottom Right
8
7
6
5
4
3
2
1
Mouth Bottom Left
1
2
3
4
5
6
7
8
Preferred consultation location
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6 Bond St, South Yarra 3141
1007 Malvern Rd, Toorak 3142
801 Toorak Rd, Hawthorn East 3123
1 Thurmond Crt, Endeavour Hills 3802
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