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Dr. Braydon Haskell
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Implants and Restorative
Implants and Restorative Dentistry Overview
Dental Implants
Implant-Supported Dentures
All-on-4
®
Implant Dentures
Full Mouth Reconstruction
Bone Grafting
Sinus Lift
Ridge Modification
Gummy Smile Treatment
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Periodontal Care & Gum Treatments
Periodontal Care and Gum Treatments Overview
Gum Disease Treatment
Cleanings and Prevention
Periodontal Maintenance
Mouth Body Connection
Exams and X Rays
Scaling and Root Planing
LANAP
®
Laser Gum Therapy
Pinhole
®
Gum Grafting
Vista (Vestibular Incision Subperiosteal Tunnel Access)
Gum Contouring
Gum Bleaching/Gum Depigmentation
Osseous Surgery
Crown Lengthening (gummy smile)
Bite Guards/Mouthguards
Bite Equilibration
Sedation Dentistry
Sedation Dentistry Overview
IV Sedation
Oral Conscious Sedation
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Contact Us
Referral Form
8415 N Pima Rd,
Suite 250
Scottsdale, AZ 85258
480.948.7000
Referral Form
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Referral Form
Introducing Patient
Date
MM slash DD slash YYYY
Email
(Required)
Phone*
(Required)
Referred By
Radiographs
Required
By Email
Preferred Implant System
Nobel Biocare
Straumann
Reasons For Referral
Full mouth / Comprehensive Evaluation
Limited Evaluation
Graft / Mucogingival Problem
Crown Lenghthening
Esthetic Consultation
Ridge Augmentation
All on 4 Dental Implants
Implant Consultation
Area of Concern
Right - 1
Right - 2
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Right - 8
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Left - 9
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Please click the link below to access the referral form as a PDF file.
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