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John N. Nasedkin, D.D.S., F.R.C.D.(C), F.A.D.M.
PATIENT OCCLUSION LETTER: You have been referred to our office for an examination for bite (occlusion) and jaw problems or for the differential diagnosis of facial pain. This examination will involve the evaluation of your entire chewing apparatus. We will assess not only the contacting relationships of the teeth, but the supporting structures (gums and bones), the jaw joints and the muscles which move the jaws as well as those muscles which support the head. Upon diagnosis a list of recommendations will be drawn up and a copy of our consultant report will be sent to you and another to your referring health practitioner. It would be helpful for you to bring with you or have sent to us any diagnostic material which will assist in the evaluation of your problem (such as : specialist's report, full mouth x-ray survey, temporomandibular joint x-rays, or diagnostic models of your teeth). Should the patient be a teenager, a parent or responsible adult should also attend. We would like you to assist us to gain a perspective on your problems in order to serve you better. Please write out a NARRATIVE REPORT listing the first symptoms which you experienced and the date (approximate) and doctors or health therapists consulted. A description of treatment provided and the duration as well as effectiveness of the treatment should be noted. Please list any changes in symptoms and subsequent medical or dental consultations and treatment up to the current time. Our fee for this consultant service, based on the care, skill and time involved within this complex area will be approximately $180.00 - $260.00 for which payment will be anticipated at the appointment. Chargex Visa and Mastercard are accepted. Medico-legal reports require a separate fee arrangement beforehand. This service is not covered under the B.C. Medical Plan and may or may not be covered wholly or partially by a dental plan. Inquiries as to your particular eligibility under a dental plan should be directed to your insurance carrier. If you wish to arrange an appointment, kindly telephone and advise us that you have received this letter. Yours Sincerely, Dr. John Nasedkin and team For dental plan appraisal: This evaluation would involve all of these services:
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