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Stration Form: be sure phone and street numbers are correctly so that we will have no difficult in contacting you. 2. Health Questionnaire: respond to all questions to the best of your knowledge if you are unsure, you might check with the appropriate family members, caregivers, or medical personnel. 3. History and Physical Examination (H&P) is required for the approval. 4. Consent for Routine Dental Treatment: print name clearly and sign. 5. Care Agreement: please read document carefully bef.

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