DATE HERE

 

Dr. Periodontist

6817 N. Cedar

Spokane, WA  99208

 

Dear Dr.Periodontist:

 

I have referred [patient name] to you for restorative/implant/perio consultation.  Perio charting and full mouth x-rays from 9/3/03 enclosed (you may keep).

  

Today we finished scale & prophy.

 

Problems noted:

 

Preliminary treatment plan:

                        (2 & 3 are first priority because of caries)

 

Possible specialist treatment:  gingival grafting; #19 implant; upright #18; crown lengthening #4.

 

Let’s get together and discuss her treatment plan after you evaluate her.

 

                                    Sincerely,

 

 

                                                                        Randy Otterholt, D.D.S.