Match fonts as close as possible. PROOF IS ON NEXT PAGE Printing Process: Preferred business PO# 82566 INK COLOR(s) & STOCK: DIGITAL 2nd Proof 02598931 advanced endodontic sc 0819.indd rev:sc 0826 cmyk flat size 6 x 7 perf @3.5 100# bright white cover It is your responsibility to verify all aspects of this proof, including size, position, type, color separation, and accurate copy! Be sure to measure the “one inch” guide to be certain you are viewing the proof at its proper size. The .pdf image setting is at “100%” does not necessarily provide you with an accurately sized image. ❏ I have verified all aspects of the proof and it is OK AS IS ❏ I have verified all aspects of the proof and it is OK WITH CORRECTIONS (no further proof required). ❏ I have verified all aspects of the proof and I require a ANOTHER PROOF (revisions noted). X_________________________________________________________ Customer Signature Page 1 Date 02598931 advanced endodontic sc 0819 DIRECTIONS TO MT. KISCO OFFICE OUR OFFICE IS LOCATED AT 359 EAST MAIN STREET IN THE CENTER OF MT. KISCO, OPPOSITE THE HOSPITAL AND NEXT TO THE BOYS AND GIRLS CLUB. • I-684 North to exit 4 (Mt. Kisco-Route172). Turn left on 172 and follow into Mt. Kisco. At the end of 172 turn right onto Main St., 359 E. Main Street is second building on the right. • Saw Mill River Pkwy. North to Reader's Digest Road (exit 33). Bear right up the hill to light. Turn left onto 117 North. Continue 2 miles into Mt. Kisco. 359 E. Main St. is on the right opposite the hospital. • I-684 South to exit 4 (Mt. Kisco-Route 172). Turn right onto 172 and follow into Mt. Kisco. At end turn right onto Main Street. 359 E. Main St. is second building on the right. • Saw Mill River Pkwy. South to exit 37 (Kisco Ave.). Left at stop onto Kisco Ave. to 2nd light. Left onto Main St. for 1 mile. 359 E. Main St. is on the left opposite the hospital. Justin Kolnick, DDS • Kara Diamond, DDS Randall Barton, DMD • Keith Hope, DDS Dr. Bilal Chaudhry, DMD Date Introducing Tooth # For Consultation & Evaluation Treatment Current Status Emergency treatment already rendered Pulp exposure Pain in quadrant Restoration cemented Temporary Permanent Final Impression Taken Post Space (PLEASE check one option) Yes, in canal No At AEW discretion Referred by Download a free QR reader to scan this code and save our APP! Or type into your smart phone or tablet. Page 2 222 Westchester Ave. Suite 402 White Plains, N. Y. 10604 (914) 946-2218 FAX (914) 946-4303 02598931 advanced endodontic sc 0819 359 E. Main Street Suite 3H Mt. Kisco, N Y. 10549 (914) 666-0707 FAX (914) 244-3065 DIRECTIONS TO WHITE PLAINS OFFICE Proposed treatment plan ON ENTERING HTA HEALTHCARE TRUST OF AMERICA, 222 IS THE LARGE BUILDING IN THE REAR. PARKING IS ACCESSED FROM THE RAMP TO THE LEFT OF THE BUILDING. (Connecticut and Interstate 95) • I 287 West to Exit 9N-S. This exits onto Westchester Ave. westbound. Follow for approximately 2 ¼ miles. HTA Healthcare Trust of America , #222 Westchester Ave. is on the right. (Tappan Zee Bridge and Tarrytown) • I 287 East to Exit 8E. Follow signs for Westchester Ave. Proceed to the second traffic light and make left turn over the W.M.L.Butcher Bridge. Turn left again onto Westchester Ave. westbound. HTA Healthcare Trust of America, #222 Westchester Ave. is on the right. Remarks • Saw Mill River Parkway or Sprain Brook Parkway to I 287 East to Exit 8E. Follow above directions from West. • Hutchinson River Parkway North to Exit 26W. This exits onto Westchester Ave. Stay on Westchester Ave. for 1 ¼ miles. HTA Healthcare Trust of America, #222 Westchester Ave. is on the right. • I 684 South to Westchester Ave. White Plains Exit. Stay to the far right and follow signs to Westchester Ave. Follow Westchester Ave. for approximately ½ mile. HTA Healthcare Trust of America, #222 Westchester Ave. is on the right. West Harrison • Merritt Parkway to Hutchinson River Parkway S to exit 26W. This exits onto Westchester Ave. Stay on Westchester Ave. for 1 ¼ miles. HTA Healthcare Trust of America, #222 Westchester Ave. is on the right. • With the Westchester Mall on your right, follow Westchester Avenue Eastbound towards I 287. Follow signs for Westchester Ave. Proceed to the second traffic light and make a left over W.M.L. Butcher Bridge. Turn left again onto Westchester Ave. westbound. HTA Healthcare Trust of America, #222 Westchester Ave. is on the right. Visit our website Page 3 02598931 advanced endodontic sc 0819
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