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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's Email

Start of your orthodontic treatment

Estimate length of your orthodontic treatment

Duration of your orthodontic treatment to date

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

How Much Do You Like Your Smile

Estimate length of your orthodontic treatment

This referral was sent to your dentist

Leave this empty:

Your legal name

Your email address

Please Confirm full name and signature.

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Timestamp

Audit

January 13, 2022 2:05 pm MST

Orthodontic Progress Report Uploaded by Won-Woo Jonathan Park - forms@ooliortho.com IP 68.104.180.82

May 11, 2024 9:30 pm MST

OoLi Team - forms@ooliortho.com added by Won-Woo Jonathan Park - forms@ooliortho.com as a CC'd Recipient Ip: 68.104.180.82

May 12, 2024 7:42 am MST

OoLi Team - forms@ooliortho.com added by Won-Woo Jonathan Park - forms@ooliortho.com as a CC'd Recipient Ip: 68.104.180.82