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4.8 out of 5

171 votes

The document is a confidential information questionnaire for patients at a dental office, collecting personal, insurance, and emergency contact details. It includes sections for patient demographics, insurance coverage, consent for communication, and authorization for treatment and release of information.

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Versions	Form popularity	Fillable & printable
2012	4.8 Satisfied (171 Votes)
2011	4.1 Satisfied (60 Votes)

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