This two-sided dental patient registration and history form is formatted for ease of use. Readability and plenty of writing room helps patients provide the information needed quickly, clearly and accurately.

• Make dental patient check-ins fast and easy with these brief Health History & Treatment Records.
• White ledger stock printed in blue ink.
• Quantity: 250 per box

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.