Eldridge Dental

Ali Sajadi, DDS, MSD

6370 N. Eldridge Pkwy, Suite B, Houston, TX 77041

P: (713) 983-0099

https://www.eldridge-dent.com/

Please email X-rays to:eldridgedentaltx@yahoo.com
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PATIENT INFORMATION
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REFERRING DOCTOR INFORMATION
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Complete Periodontal Evaluation(Early)Complete Periodontal Evaluation(Moderate)Complete Periodontal Evaluation(Advanced)Guided Tissue Regeneration (GTR)Gingival Contouring for Cosmetic RestorationCrown LengtheningRidge AugmentationGrafting for root coverageComplete Oral Surgery EvaluationExtractionsWisdom TeethImplant ConsultationSurgical template/guide
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Plaque control instructionsScaling & root planing (SRP)No periodontal treatment renderedProphylaxis/Gross scalingPeriodontal maintenance (PMT)
Have you advised the patient of the possibility of extractions? If so, which tooth number(s)?
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If so, what is planned?
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PATIENT INFORMATION