PATIENT INFORMATION & REGISTRATION FORMS (367-4672) CLINICAL FORMS Adult Adult Front (367-3634) Front Back Back PATIENT HISTORY REGISTRATION FORMS * Capture patient information with one colorful form * 2-sided format easily gathers personal data, insurance information, dental and medical histories, and more * Printed on 28-Lb. ledger stock on pads of 100 sheets * 81⁄2 " W x 11 " H Forms�������������������������������������������������������������������100 per Pkg. For Imprinted Materials, contact: professional.promotions@henryschein.com 48.99 To order, visit: www.henryscheindental.com 155