OFFICE SUPPLIES CLINICAL FORMS (341-6235) (341-6576) 2-SIDED RECORD FORM * Streamline your patients' documentation with this comprehensive form * Printed on sturdy, 7 pt. return postcard stock * 11 " x 81 ⁄2 " in both vertical and horizonal formats Specify: ......................................................................100 per Pkg. 5 Pkg.@ (341-6576) (341-6235) (341-6503) (341-6503) Front Back RE-EXAM RECORD WITH HEALTH HISTORY UPDATE ⁄2 " W x 81 ⁄2 " H Back * 2-sided form and smaller format keep records accurate and up to date * Features tooth charts on the front as shown * Printed on sturdy ledger stock * 51 (367-3432)......................................................... 250 per Pkg. (369-0033) Opaque Stock Front Back (369-0030) Opaque Stock Front EXAM/ACCOUNT RECORD FORM * Front of this 2-sided form features " 1-32 " numbering, " a-t " lettering, and an area to summarize patient history * Back side has space to list services needed or rendered and fees * Printed on sturdy ledger stock * 81 ⁄2 " x 101 ⁄2 " horizontal (367-3430)......................................................... 250 per Pkg. For pricing information and/or to place an order, visit: www.henryscheindental.com DENTAL RECORD FORMS * Detailed form captures all of your important clinical findings * Designed with space for clinical findings, patient histories, estimates, charting, charge information, and progress notes * Printed with green ink on 80 Lb. offset opaque stock 80 Lb. Opaque Card Stock................................. 100 per Pkg. (369-0030) Specify: 1 Sided 2 Sided Section 36-70 (369-0033) Front (Back not shown)