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Get Dental Refusal Of Treatment Form

REFUSAL TO CONSENT TO DENTAL TREATMENT Patients Initials I understand and refuse the following treatment, medication, examination, or procedure recommended by my dentist: . I am aware that this refusal.

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  2. Complete the requested fields which are yellow-colored.
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  4. Use the e-autograph solution to add an electronic signature to the form.
  5. Add the date.
  6. Check the entire document to be sure that you have not skipped anything.
  7. Hit Done and save the resulting document.

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