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Dental History What would you like us to do for you today Former Dentist Address Phone Date of last dental care Date of last x-rays How often does your child brush Floss Does your child experience pain or discomfort in the jaw joint Yes / No Has your child ever experienced mouth or chin injury Child s habits affecting the mouth or teeth Thumb sucking Nail biting Other Other information about your child s dental health or previous treatment Medical History Child s Physician Phone Last Visit...
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