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703-955-5234
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Home
About Us
Meet the Doctor
Blogs
Services
General & Preventive Dentistry
Crowns & Ceramic Restorations
Clear Aligners & Orthodontics
Cosmetic Dentistry
Teeth Whitening
TMJ & Orofacial Pain
Referrals
Financing
Contact Us
43480 Yukon Drive, Suite # 204,
Ashburn, Virginia
703-955-5234
info@smilecraft.ai
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Dr. Rashmi Kolichala
BDS, DMD, DABOP, AADSM Qualified Dentist
Date
Patient Name
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Doctor Name
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REASON FOR REFERRAL
Facial pain
TMJ disorders
Pain or soreness around the jaw joints
Sleep Apnea or Snoring intra-oral appliance treatment
Headaches
Bruxism, clenching, and grinding
Neck or shoulder pain
Burning mouth/tongue
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