Online Referral | Sunshineperio

Exam Type: Required

Comprehensive Evaluation

Limited Evaluation

Reason for Referral

Periodontal Pockets

Crown Lengthening

Gingivectomy/Gingival Hyperplasia

Gingival recession/Lack of attached gingiva/Root Sensitivity

Peri-implantitis/Peri-implant mucositis

High Frenum Attachment/Frenum Pull

Red/White Lesions (Biopsy)

Reason for Referral

Select Quadrant(s)

Select Tooth/Teeth Numbers: