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How to use or fill out CT Dental Scan Appointment Form - Lake Forest Hospital - lfh

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Click ‘Get Form’ to open it in the editor.
Begin by entering your personal information in the 'Patient Information' section. Fill in your last name, first name, date of birth, and contact numbers.
Indicate whether a stent is required for your procedure by selecting the appropriate option. If applicable, provide details for results delivery to your physician.
In the 'Physician Information' section, enter the referring practitioner's last name, first name, NPI number, and fax number. Ensure all details are accurate for seamless communication.
Review any notes or special instructions regarding symptoms or diagnoses. This is crucial for proper documentation and billing.
Finally, sign and date the form at the bottom before submitting it to registration on your appointment day.

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Versions	Form popularity	Fillable & printable
2018	4.8 Satisfied (135 Votes)
2012	4.1 Satisfied (55 Votes)

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