Create New Treatment Plan

Before You Begin

Fill out the form below with the patient and treatment details. All fields marked with an asterisk (*) are required. You'll be able to preview the plan before finalizing it.

Patient Information

Full Name *

Please enter a valid name (2-100 characters).

Date of Birth *

Please select a valid date of birth.

Phone Number *

Please enter a valid phone number.

Email Address *

Please enter a valid email address.

Dentist/Clinic Information

Dentist Name *

Please enter the dentist's name.

Dental Office Name *

Please enter the dental office name.

Office Address *

Please enter the office address.

Treatment Procedures

Quick Add Procedure:

Total Cost: $0.00

Additional Notes

Notes or Instructions (Optional)

You can include post-treatment care instructions, follow-up recommendations, or any other important details.