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SLO Dental Practice Welcome - Website 2025

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The document is a comprehensive patient information and consent form for S.L.O. Dental Practice, detailing the dental care services provided, patient responsibilities, medical and dental history inquiries, insurance information, treatment consent, and payment policies. It emphasizes the importance of accurate information for health safety, outlines potential risks associated with dental procedures, and provides various payment options to accommodate patients' financial situations.

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Click ‘Get Form’ to open it in the editor.
Begin by entering the date at the top of the form. This helps us track your visit accurately.
Fill in your personal information, including your name, birthday, and social security number. Ensure all details are correct for confidentiality.
Provide your address and contact numbers. This information is crucial for communication regarding appointments and follow-ups.
Indicate your marital status and employment details. If you are a student, please include the name of your school or college.
Complete the insurance information section if applicable. This will assist us in processing any claims efficiently.
Answer the medical history questions honestly to ensure safe treatment. If unsure about any question, feel free to ask for clarification.
Review all entered information for accuracy before submitting the form to avoid delays in service.

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