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Orthodontic Progress Report

Won-Woo Jonathan Park

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Orthodontic Progress Report

Signed Date

Date

Patient Name

Date of Birth

Patient Email

Parent/Guardian Name

Parent/Guardian Email

Patient's Dentist

Patient's Dentist

Patient's Dentist's Email

 

Please see below for progress of your orthodontic treatment

Start of your orthodontic treatment

Estimate length of your orthodontic treatment

Duration of your orthodontic treatment to date

Duration of your orthodontic treatment to date

Angle Clarification

Overjet (mm)

Overbite Percentage

How is your orthodontic treatment progressing?

Why is your orthodontic treatment progress poor?

What needs to improve?

How is your brushing/oral hygiene?

Estimate of time remaining before completion of your orthodontic treatment

 

Patient's Self Assessment

How Much Do You Like Your Smile

Estimate length of your orthodontic treatment

 

This referral was sent to your dentist

Please Review & Sign This Document

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Orthodontic Progress Report

Won-Woo Jonathan Park

Please review the document below

Thank you for signing your document. If you need to fill out any additional documents, you can do so here: https://ooliortho.com/patient-forms/ If you've already filled out and signed what you need, there's nothing else you need to do except show up for your appointment! Congratulations! We look forward to meeting you!

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