Consultation

Patient Details

Identification & contact information

Patient Name (first & last)

Date of Birth (DD/MM/YY)

Email Address

Consultation Form

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Recipient Regions

Draw the recipient regions on the patient.
Label each in order to reference graft volume below.

Regions & Graft volume:

Notes

Consultation Form

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Photograph Patient

Take 4 images of the angles highlighted below.

Left

Center

Right

Top

Consultation Form

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Send Images

Please send the images to the patient folder

Completed

Not Completed

Consultation Form

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Confirm Submission.

Once submitted, we will begin rendering the patient simulation.

Consultation Form

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