Dental Facebow Transfer Record Form
Record essential details of a facebow transfer for accurate mounting of the maxillary cast in dental laboratory or clinical settings.
Patient Identifier (Name or Chart Number)
*
Referring Dentist or Clinician
*
Date of Facebow Transfer
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Facebow Type/Model Used
*
Please Select
Artex Facebow
Denar Slidematic Facebow
Whip Mix Facebow
Hanau Facebow
SAM Facebow
Other
Transfer Orientation / Mounting Approach
*
Please Select
Kinematic (Hinge Axis)
Arbitrary Axis
Ear Bow
Facial Reference Plane
Other
Impression/Cast Side or Arch
*
Maxillary
Mandibular
Both
Other
Bite Registration / Reference Taken
*
Please Select
Centric Relation
Intercuspal Position
Protrusive Record
Lateral Record
Other
Articulator Type/Model
*
Please Select
Artex
Denar
Whip Mix
Hanau
SAM
Other
Notes on Fit, Landmarks, or Issues Encountered
Technician Acknowledgement / Completion Confirmation
*
Transfer Completed and Verified
Issues Noted (See Notes)
Other
Submit
Should be Empty: