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Regions of interest of CBCT scan- Maxilla
Regions of interest of CBCT scan-MANDIBLE
Regions of interest of CBCT scan-both
Regions of interest of CBCT scan-TMJ
Regions of interest of CBCT scan-RIGHT
Regions of interest of CBCT scan-LEFT
Regions of interest of CBCT scan-tooth as indicated below
Regions of interest of CBCT scan-teeth as indicated below
Tooth Number(s)
Scan Patient
Reason for CBCT scan - to evaluate
I.N.Click to Sign
Do not send an interpretation
Additional/other studies requested
x

Additional Signatures Required