CLINICAL FORMS PATIENT INFORMATION & REGISTRATION FORMS Child Adult (366-8423) ADULT AND CHILD REGISTRATION FORMS Back * Comprehensive, full-color forms warmly welcome patients * Full-color, 2-sided forms are updated regularly to provide the caregiver a thorough understanding of the patient's dental and medical history * Features complete insurance information with a signature for assignment benefits * Allergy section covers drugs, latex, and metals * 81⁄2 " W x 11 " H Forms�������������������������������������������������������������������100 per Pkg. 44.99 154 (366-0642) Front To order, visit: www.henryscheindental.com Front Back