Eligibility

Pre-eligibility assessment.

The first check for the 72 hour protocol starts with X-rays, mouth photos and basic health information.

1. X-Ray or photos are uploaded.

2. The clinical team performs a preliminary review.

3. If suitable, treatment and travel planning are discussed.

This form does not diagnose; it collects information to prepare for doctor assessment.

72 Hour Smile Plan

Complete the form.