Geoff Bills
Prudential Building, 9th Floor, 195 North Terrace, Adelaide, S.A. 5000 Phone 08 8223 5266 Fax 08 8223 2399 email gbills@adelaide.on.net www.hackneylab.com.au
DATE SENT:
DENTIST: PHONE:
PATIENT: AGE:
SHADE: CASE:
TEETH:
PREFERRED ALLOY TYPE:
RIDGE RELIEF: NONE SLIGHT MED. HEAVY
CONTACTS: OPEN CLOSED
PONTIC DESIGN: FULL RIDGE PARTIAL RIDGE NO RIDGE POINT CONTACT NO CONTACT
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