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DAVID A. CARBONARO D. D. S. Diplomate American Board of Periodontology 480 Perinton Hills Office Park Fairport New York 14450 Phone 585 223-6040 Fax 585 223-3266 INTRODUCING REFERRED BY TODAY S DATE APPOINTMENT DATE/TIME Welcome to our periodontal practice. REASON FOR REFERRAL Comprehensive Periodontal Evaluation Implants Isolated Procedure Emergency Problem Other comments RADIOGRAPHS Periapicals Mailed REQUIRES PREMEDICATION The initial visit with the exception of emergency care is for...
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