Dental Patient Treatment Form
Size: 5-1/2" X 8-1/2"

Record patient conditions, recommended services and fees in one, compact and convenient form.

• Includes universal tooth chart for easy notations and referencing.
• Makes up to 5 copies at a time.
• White carbonless stock printed in black ink.
• Quantity: 500 (5 pads of 100)
  

FREIGHT CHARGES
ACS always confirms to our customers total amount to be charged including freight costs before order
is processed.

RETURNS
There is a 15 day return policy. Customers have 15 days to return products after they have received them. Products are not returnable after this time. Returns are subject to a restocking fee of 25%. If the return is a result of our error, we will issue a call tag. We grant returns on products only if the product and the packaging are in re-sellable condition. Custom products are not returnable.

SALES TAX
ACS charges sales tax if you are a Texas resident, Texas State Sales Tax will be added at the time your
order is invoiced. If you are tax exempt you must provide a Texas Sales Tax Exemption Certificate.