CHITTUM LABORATORIES
 

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Critique Card

Date:

Doctor:

Patient:

Restoration Type and Number

         

Excellent

Good

Fair

Needs Improvement

Shade:

Contacts:

Contour:

Emergence Profile:

Margins:

Occlusion:

Polish:

Overall Result:

   
Comments:

Doctor and staff please fill out and Send evaluation information. Be honest and as constructive as possible, do not spare our feelings. This information helps evaluate our finished product as well as monitor areas of improvement. We Thank and Appreciate your time in this area.

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Revised: Thursday, March 6, 2008

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