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RHPD New Patient Forms - Rock Hill Pediatric Dentistry 2025

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The document is a comprehensive patient information form for Rock Hill Pediatric Dentistry, designed to gather essential details about a child's dental and medical history, as well as parent or guardian information. It includes sections for consent to treatment, financial policies, appointment policies, and electronic communication preferences. The aim is to ensure effective dental care and communication while maintaining confidentiality.

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Click ‘Get Form’ to open the RHPD New Patient Forms in our editor.
Begin by filling out the 'Patient Information' section. Provide your child's full name, preferred name, gender, age, and date of birth. Include interests or hobbies to help us know your child better.
Next, complete the 'Parent/Guardian Information' section. Indicate your relationship to the patient and provide all requested contact details including home and cellular phone numbers.
In the 'Dental History' section, answer questions regarding your child's dental visits and habits. This information is crucial for tailoring their care.
Proceed to the 'Medical History' section. Fill in details about your child's pediatrician and any medical concerns or allergies they may have.
Finally, review the 'Consent for Treatment' and 'Financial Policy' sections. Ensure you understand these policies before signing at the end of the form.

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