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General Case Description Form
Thank you.
The Team at Bioart Dental
Dentist
Surname
Given Name
Dentist Email
Client
Surname
Given Name
Age
Male
Female
Date
Date Required
Time Required
Try In
Finish
Check List
Alginate Impression
U
L
Study Model
U
L
Articulator
Working Dies
1
2
Base Plates
1
2
Working Model
U
L
Diagnostic Wax-Up
U
L
Crowns
Registration
Shades
Y
N
Others
Restoration Type
Porcelain Fused Metal
Nobel Yellow (BG)
Zirconia
Nobel White (BG)
E-Max
Non Precious
Composite Crown
Titanium
Post / Core
Full Metal Crown
Occlusal Stain
If no occlusal clearance
None
Adjust opposing
Medium
Metal Occlusal
Light
Transfer coping
Dark
Call Dentist
Preparation Detail
Core Shade
Cosmo Post / Core
Vital
Composite Post / Core
Non Vital
Metal Post / Core
Margin and Metal Design
Pontic Design
Case Description Shades
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