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Tell Us About Your Child Today's Date: Child's Name: First Middle Last Male Birthdate: / / Child's Home #: () (Nickname) Female SS #: Child's Home Address: CITY STATE ZIP Previous/Present Dentist:
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Today's date is October 14, 2021
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Simply write down today's date in the format MM/DD/YYYY
Today's date is used to mark the current day in time
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