Register Patient – Digital Dental Diagnostic

Report and image portfolio

- PATIENT INFORMATION
- Name
- First Name*
- Last Name
- Date of birth
- E-mail*
- Password* Minimum length of 8 characters.
  The password must have a minimum strength of MediumStrength indicator
- CLINICAL INFORMATION
- Diagnosis
- Specific Areas
  - Implants
  - Impacted Teeth
  - Pathology
  - Endodontics
  - Orthodontics
  - TMD
  - Airways.
- UPLOAD CASE
- Requirements
- UPLOADUpload (UPLOAD (CBCT DICOM file (must DICOM file before uploading) / 2D image in .JPG or .DCM)

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Demo Description

Name
First Name*
Last Name
Role*
Your Focus Area(s)*
- General Dentistry
- Cosmetic Dentistry
- Implant Dentistry
- Endodontics
- Pediatric Dentistry
- Orthodontics
- Prosthodontics
- Periodontics
- Sleep Specialist
- ENT
- Other
*
- Chairside care
- 3D Imaging
- Office administration
- Other
- Practice management
Practice Details
Practice Name*
Adress Line1
Adress Line2
City
State
Zip Code
Phone*
Do you want to add a doctor/staff memeber for your practice?
- yes
- no
Name
Last Name
Email
Contact Info
E-mail*
Password* Minimum length of 8 characters.
The password must have a minimum strength of MediumStrength indicator
Repeat Password*
Date of birth
Diagnosis
Specific Areas
- Implants
- Impacted Teeth
- Pathology
- Endodontics
- Orthodontics
- TMD
- Airways.
Mail Results*
CLINICAL INFORMATION
UPLOAD CASE
PATIENT INFORMATION
Requirements
UPLOADUpload (UPLOAD (CBCT DICOM file (must DICOM file before uploading) / 2D image in .JPG or .DCM)
*
Phone* Required phone number format: (###) ###-####
Email

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