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Bisphosphonate Informed Consent Form

Designed for your patients who are now taking, or have taken in the past, medications known as “bisphosphonates.” Outlines general risks these individuals may encounter while in orthodontic treatment

$10.00 - Bisphosphonate Informed Consent Form
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Headgear Container Label

Help your patients prevent loss and alert them to safety precautions with these self -adhesive cloth labels. (Roll of 50)

$9.00 - Headgear Container Label
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History Form For Patient With Temporomandibular Disorder Pack of 50

This history form for patients with temporomandibular disorder may be used in conjunction with the Medical History Form. It provides a more comprehensive overview of the patient's history of TMD.

$10.00 - History Form For Patient With Temporomandibular Disorder
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Informed Consent For The Orthodontic Patient ***(SPANISH)***

Walk your Spanish-speaking patients through the informed consent process. (Pack of 50)

$25.00 - SPANISH Informed Consent For The Orthodontic Patient
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Informed Consent For The Orthodontic Patient (ENGLISH)

Walk your patients through this form outlining 19 risks associated with orthodontic treatment in one page. The signature page covers consent to undergo orthodontic treatment. English (Pack of 50)

$25.00 - Informed Consent For The Orthodontic Patient - Risks and Limitations of Orthodontic Treatment
$25.00 - Informed Consent For The Orthodontic Patient - Risks and Limitations of Orthodontic Treatment
$25.00 - Informed Consent For The Orthodontic Patient (ENGLISH)
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Medical Dental History Form - Adult

Four-page adult medical and dental history form for confidential use in your office. Pack of 50

$10.00 - Medical Dental History Form - Adult
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Medical Dental History Form - Patients Under 18 Years

Four-page child medical and dental history form for confidential use in your office. Pack of 50

$10.00 - Medical Dental History Form - Patients Under 18 Years
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Orthodontic Endorsement Form

Half-sheet duplicate form with self-adhesive backing to be used as an overlay with patient claim form. (Pack of 50)

$10.00 - Orthodontic Endorsement Form
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Patient Transfer Form - Active Treatment

Use when a patient in active treatment needs to transfer his/her care to another orthodontist. (Pack of 50)

$10.00 - Patient Transfer Form - Active Treatment
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Patient Transfer Forms - Retention

Transfer form for patients in retention (Pack of 50)

$10.00 - **RETENTION** Patient Transfer Forms (pack of 50)
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Request For Release of Patient Records Forms (pack of 50)

Provides formal documentation of a patient's request for release of records.

$10.00 - Request For Release of Patient Records Forms (pack of 50)
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Return Correspondence Regarding Requested Treatment Form Pack of 30

Useful for referring patients to other healthcare providers for services necessary to the successful completion of treatment. The form documents a thorough description of the requested procedure.

$5.50 - Return Correspondence Regarding Requested Treatment Form
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