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Dental Health History Questionnaire
Patient Health History in Spanish
 
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List Price: $95.00
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Unit Qty: 250
Unit: pack
Overall Dimensions: 8-1/2" W x 11"


Product Code: 4046V
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Description Freight, Returns & Sales Tax Policies
 
Health history questionnaire allows you to quickly obtain comprehensive dental & medical information.
  • Simple checklist format. Forms use a series of questions designed to prompt responses through a simple checklist format.
  • Easy to read. Dentist can quickly scan the completed form & identify problem "yes" areas to discuss with the patient.
  • Double-sided. Printed on 2 sides on white ledger stock.
  • Includes: 2-hole punch with check-off boxes.

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