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Type of form: Registration and history form
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250 per pack
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Size: 8 1/2″ x 11″
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Binding type: Loose
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Design: Welcome, Toothbrush, Teal
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Number of parts: 1
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Gathers complete personal information, dental history and insurance information plus assignment and release for account setup
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Printed both sides on 24 lbs. bond in teal ink



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