Treatment Submission Smile & Pass It On! treatment Form Please enable JavaScript in your browser to complete this form.First Name* *Last Name* *What treatment option would be most suitable for you? *Broken Bracket (4+)Laser: Gingivectomy | Exposure | FrenectomyGummy Smile | TADsRelapse AlignersPermanent Tooth ExtractionConvert: P1 to FullConvert: Braces | AlignersAligner Case OpeningContract Extension (+6 months)Debond FAOtherPlease describe if "Other"CommunicationDiscussed With Patient (if adult) or Parent (if minor)Parent Not PresentReasonNon-complianceAppointment HistoryNon-compliance & Appointment HistoryLaser Procedure? *GingivectomyExposureFrenectomy (Lip)Frenectomy (Tongue)Scan Complete? *YesNoTeeth Requiring Gingivectomy *Upper 5-5Lower 5-5Upper and Lower 5-5What tooth or teeth need exposure? *Ext *U4'sOtherOther *Has treatment recommendation been discussed with patient or parent?YesNoTiming *ASAPAt Debond4 Weeks After DebondOptionalCommentsubmit
