SimPlant - TP טופס הזמנת
HApro TP eForm (v1.1)
Please complete one TP eForm for each jaw.
Dentist 1 - Full Name *
Your answer
Address, Phone and e-mail *
Your answer
Dentist 2 - Full Name
Your answer
Patient Full Name *
Your answer
Is a CT scan available? *
We recommend the CT is less than 4 months old and the CT scan is done in Closed Centric Occlusion.
CT Center *
Please enter the details of the CT Center as: Address, Phone, e-mail and contact person.
Your answer
Enter patient CT data:
Patient full name, Patient ID, Scan Date, Date of Birth (as recorded in the CT printout or PDF)
Your answer
Jaw *
Current Status *
Teeth to be extracted
For example: 44, 45, 37 -or- Full clearance
Your answer
Preferred surgical procedure
Was a radiographic stent used during the CT scan?
Are there plaster study models available? *
Desired quantity of implants *
For example: 8 implants -or- From 2 to 6 implants (for more than one option to be included in the TP)
Your answer
Preferred implant locations:
For example: 44, 45, 37
Your answer
Preferred Implant Brand(s) *
Your answer
Special Implant Plan Configuration
Bone Grafts Options
Is immediate loading desired? *
Preferred restoration: *
Digital images of patient
Recommendation to send pictures: facial, facial high smile line, profile, full occlusion with retractors.
Preferred SurgiGuide Platform:
SurgiGuide Types
Special conversion requests
As separate masks for particular teeth, impacted teeth, old implants, etc.
Your answer
MORE COMMENTS
FOR ANY QUESTION PLEASE CALL THE HAPRO HELP DESK 03 6138777 (int. 109)
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