Zzzz2014 Treatment Plan Wax-up Template copy: Fill out & sign online

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Click ‘Get Form’ to open the zzzz2014 Treatment Plan Wax-up Template in our editor.
Begin by entering the patient's name and the date requested in the designated fields at the top of the form.
In the 'Rx: Treatment Plan Wax-Up' section, check off any relevant items such as 'Prep Teeth', 'Impression', or 'Tooth Colored Wax' based on your treatment plan.
Fill in the 'Date Received' field once you have received the necessary materials for processing.
For additional options like 'Crown & Bridge Wax' or 'Implants', mark the appropriate boxes to indicate what is included in your treatment plan.
Draw a shade map on the provided area, specifying details such as Shade, Texture, Base Value, and Base Chroma as needed.
Finally, ensure to sign and include your license number at the bottom of the form before saving or sharing it.

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