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Last Name: Dazo

First Name: Dorothy Jake

Middle Name: Quebec

Birthdate: June 16, 1975

Age: 46

Street: Manzanillo

Barangay: Greatwoods

City: Bacoor

Country: Philippines

Zip Code: 1402

Contact number: 09293125646

Email: Dothyjake@gmail.com

Procedure: 10/16/21 OP check up 12/01/21 - impression on U&L arch -(+) clicking, (+) migraine -LOAD TESTING: (+) tension on lower neck area, bite on R side -Didn't proceed in facebow transfer and bite registration due to tension on the neck area -Possible occlusal imbalance due to previous orthodontic treatment and extraction of other teeth ***for resto esthetic: 11/21/23/42/33 *** reg resto: 38/37/36/34/35 ***ameloplasty- MLi cus 45/ inc 31

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Retain Record: Yes