Dental Implant Post-Operative Follow-up Form
Patient Name
Date of Birth
Date of Surgery
Follow-up Date
Surgeon Name
Implant Site(s)
Chief Complaint
Healing Assessment
Extraoral Findings
Intraoral Findings
Soft Tissue Condition
Pain Level
None
Mild
Moderate
Severe
Swelling
None
Mild
Moderate
Severe
Signs of Infection
No
Yes
Implant Mobility
No
Yes
Radiographic Evaluation
Post-Operative Instructions Given
Medications Prescribed/Continued
Next Follow-up Scheduled
Additional Notes
Clinician Signature