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I authorize the dental staff to perform the necessary dental services my child may need. Signature of parent or guardian Our office is HIPAA compliant and is committed to meeting or exceeding the standards of infection control mandated by OSHA the CDC and the ADA. Diabetes Does your child brush daily Hearing Impairment Hemophilia Hepatitis Hives HIV / AIDS Kidney Problems Liver Problems Lupus Measles Mononucleosis Mitral Valve Prolapse Physical Disabilities orthodontic treatment before Have...
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