PATIENT INFORMATION - CHILD

Please correct the errors described below.

PLEASE NOTE:

  • Regular visits to your dentist must continue during orthodontic treatment
  • Some appointments will infringe on school time or work

HAVE YOU OR HAVE YOU EVER HAD ANY OF THE FOLLOWING:

Do you have any of the following habits?

I give permission to allow Drs. D. Sonya and J. Nagamatsu to report any findings to my dentist or any other dental professional as they deem necessary. I also give permission for any records made in the process of examination, treatment and retention to be used for purposes of research, education or publication in professional journals.

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