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Get Perio Refusal Form
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How to fill out the Perio Refusal Form online
The Perio Refusal Form is an important document that allows patients to formally decline recommended periodontal treatment after being informed of their condition. This guide provides clear instructions to help you complete the form online with ease.
Follow the steps to fill out the Perio Refusal Form online
- Click ‘Get Form’ button to obtain the form and open it in the editor.
- Begin by entering your full name in the designated field marked 'Patient Name (Print)'. Ensure your name is legible and matches official documents.
- Next, review the information regarding your periodontal disease, which includes potential risks and the recommended treatment. Acknowledge your understanding by reading this section carefully.
- Proceed to the 'Patient Signature' section. Use your mouse or touchpad to create a clear signature indicating your decision to decline the treatment.
- After signing, enter today's date in the provided space next to your signature. This date should reflect when you are completing the form.
- Continue to the 'Hygienist' and 'Dentist' sections. You may need to provide their names and dates as applicable; ensure this information is correct and updated.
- Once all required fields are filled out, review the form for any errors or missing information to ensure it is complete.
- Finally, save your changes, and download, print, or share the form as needed for your records.
Complete your Perio Refusal Form online today for a smooth documentation process.
Arianna said her patients who use Perio Protect tray therapy have shown improvement, most getting amazing results. She said patients love the side effects: whiter teeth and fresher breath.
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