Implant Clinic Xray/ CBCT upload
Fast, secure upload for xrays and medical records
X-rays
X-rays Upload (browse)
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Attach all recent films, PAX, BW or PAN
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CBCT upload
CBCT upload (browse)
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Attach all recent films, PAX, BW or PAN
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Medical history upload
Medical history upload
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Upload medical hx and medications (if applicable)
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Patient photos
Patient photos
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Referring Dental Office
*
Dental Clinic
Dentist
Patient Name
*
First Name
Last Name
Phone Number
Best contact number for patient or caregiver.
Birth Date
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Month
-
Day
Year
Date
Submission date
*
-
Month
-
Day
Year
Date of X-rays
*
Caregiver name / phone
If applicable: Contact for appointments
Send to IPC- HIPPA secure
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