Ian Aires, D.D.S Lukas Pytlik, D.M Aires, D.D.S Lukas Pytlik, D.M.D Prosthodontics 4130 La Jolla...
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Ian Aires, D.D.S Lukas Pytlik, D.M.D Prosthodontics 4130 La Jolla Village Drive, Ste. 204 La Jolla, CA 92037 Phone (858) 452-8933 Email: [email protected] Fax (858) 452-5927 www.drlukaspytlik.com ______________________________________________ Referring Dr. Date Patient Patient Phone Appointment Day/Date/Time Radiographs: Mailed Emailed w/ Pt Pre-Medication Needed? Yes No Evaluation Requested For: Crowns/ Bridges Implant Supported Restorations Dentures/Partials Full Mouth Reconstruction Esthetic Design Patient main concern: __________________________ Comments: ____________________________________
Transcript of Ian Aires, D.D.S Lukas Pytlik, D.M Aires, D.D.S Lukas Pytlik, D.M.D Prosthodontics 4130 La Jolla...
Ian Aires, D.D.S
Lukas Pytlik, D.M.D
Prosthodontics
4130 La Jolla Village Drive, Ste. 204
La Jolla, CA 92037
Phone (858) 452-8933 Email: [email protected]
Fax (858) 452-5927 www.drlukaspytlik.com
______________________________________________
Referring Dr. Date
Patient
Patient Phone
Appointment Day/Date/Time
Radiographs: Mailed Emailed w/ Pt
Pre-Medication Needed? Yes No
Evaluation Requested For:
Crowns/ Bridges
Implant Supported Restorations
Dentures/Partials
Full Mouth Reconstruction
Esthetic Design
Patient main concern: __________________________
Comments: ____________________________________
![Krzysztof Pacześniowski , Andrzej Pytlik , Ewa Radwańskajournals.bg.agh.edu.pl/GORNICTWO/2007-03-1/GG_2007_3-1_36.pdf · — ciernych złączy odrzwi obudowy ŁP, ... [3] PN-G-15536:1998:](https://static.fdocuments.pl/doc/165x107/5c77982509d3f2322f8c4898/krzysztof-paczesniowski-andrzej-pytlik-ewa-radwan-ciernych-zlaczy.jpg)
