Treatment Estimate

An all-purpose treatment conference tool

This form may be used for all types of treatment conferences. It documents exact financial arrangements and co-payments for your patient and supplements the informed consent process. (Click on Informed Consent Forms on products page). Use this form to eliminate disputes over finances and treatment.

  • Financial arrangements to fit any office
  • Service Charge - implement if applicable
  • Dental Insurance - patient responsibility
  • Informed Consent
  • Most common dental treatment procedures listed on one easy - to - use form
C-112L Treatment Estimate
$18.00 / 200 $34.00 / 400
$64.00 / 800 $120.00 / 1600



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