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Any credit granted shall be paid within 90 days or in accordance with any written agreement. I agree that if I am delinquent of above terms that the credit grantor may add late payment fees not to exceed 1 per month 18 annum or 5. To the best of my knowledge all of the preceding answers are true and correct. If I ever have a change in my health history of if my medications change I will inform the Doctor of Dentistry at my next appointment. I hereby authorize payment directly to this office...
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