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DENTAL REFERRAL FORM Urgent RoutinePlease complete both sides and every section of this form and retain a copy for your records Incomplete referrals will be returned. Attached rays & periodontal charts
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What is DENTAL REFERRAL UrgentRoutine Form?

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The dental referral formurgentroutine is a document used to refer a patient for urgent dental treatment.
Dentists or doctors who identify an urgent dental issue that requires immediate attention are required to file the referral formurgentroutine.
To fill out the dental referral formurgentroutine, the referring dentist or doctor must provide details of the patient's condition, the urgency of the treatment required, and any other relevant information.
The purpose of the dental referral formurgentroutine is to ensure that patients with urgent dental needs receive timely and appropriate treatment.
Information reported on the dental referral formurgentroutine includes the patient's name, contact information, medical history, current dental issue, and the urgency of the treatment required.
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