Dental report

The Plan

Name:

Patient ID:

Dear:

Thank you for choosing Rose Medical Clinic for your dental care. We appreciate the opportunity to serve you. After a thorough examination, we would like to share the findings & recommenda- tions for your dental health.

Medical plan:

Visit details:

Dental report

The Cost

1st visit cost:

Treatment Type

Brand

Quantity

Cost per one

Total

Important Payment and Appointment Information

Please take note of the following details: