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Patient
Who is this visit for?
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PS
Priya Sharma
Patient #00142
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Routine recall
Every 6 months
Their routine return interval — change it to update this patient.
Name
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Phone
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Date of birth
Routine recall
Every 3 days
Every 5 days
Every 7 days
Every 6 months
Every 12 months
No routine recall
Custom…
Address
Medical alerts / allergies
Anything that affects treatment — shown on every visit.
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Visit
Date
Type
Consultation
Treatment
Clinic
Tarangka Dental, Pune
Smile Care, Pune
Bloom Dental, Mumbai
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Treating dentist
Dr. Priyangka (you)
Dr. S. Menon
Dr. A. Pillai
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Did the patient come?
Came
No-show
Cancelled
A missed visit carries no fee, but the patient stays on your due list.
What was done
Whole mouth / not tooth-specific
Teeth involved
Work done
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Part of a course
Multi-visit work like a root canal or crown
Course
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New course name
This visit leaves the course…
Still ongoing
Done
Follow-up
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When should they come back?
Leave blank if nothing is pending. Appears on your due list.
Money
Fee for this visit
₹
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Lowers their running balance
Amount paid
₹
Method
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Notes
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Notes
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