Reantaso Dental Clinic: New Record
Adds a new record of service to a registered patient.
Patient Name
*
Automatic. Do not input manually.
Date
*
-
Month
-
Day
Year
Record Date
Extraction
Normal
Wisdom Tooth
Quantity
*
Please Select
1
2
3
4
5
6
7
8
9
10
Area(s)
Price
*
Subtotal
Dental FIllings/Pasta/Laser
Quantity
*
Please Select
1
2
3
4
5
6
7
8
9
10
Area(s)
Price
*
Subtotal
Temporary FIllings
Quantity
*
Please Select
1
2
3
4
5
6
7
8
9
10
Area(s)
Price
*
Subtotal
Oral Prophylaxis
Light
Moderate
Heavy
Subtotal
*
Prophylaxis
Complete Denture
Regular
Flexure
Thermosen
Subtotal
*
Complete Denture
Jacket Crown
Price
*
Prophylaxis
Removal Partial Dentures
Subtotal
*
Partial Dentures
Retainer
Subtotal
*
Retainer
Consultation
Subtotal
*
Consultation
Other treatments:
Description
Quantity
*
Please Select
1
2
3
4
5
6
7
8
9
10
Area(s)
Price
*
Subtotal
Grand Total
Amount Paid
*
Documents Issued
Dental Certificate
Prescription
Details
*
Details of document issued
Follow-up Appointment
Details
*
Reason for follow-up appointment
Submit
Should be Empty: