COSMETIC CASE

PLEASE COMPLETE THE BELOW FORM

By providing us with the below information and photos, it enables us to provide a better aesthetic and functional outcome for your patient.

Dentist & Practice Name

Patient Name

Case Description

What does the patient want to achieve?

Stump Shade

Please include a photo with shade guide if possible.

Required Photos

TIPS: Please show the full face of the patient. Please make sure their ears are visible. Please take off patient's glasses. Make sure chin is down. Encourage a natural and big smile.

PROFILE (FRONT ON)

RIGHT & LEFT PROFILE (SIDES)

PATIENT SMILING

Any additional information?