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Piedmont Regional Dental Clinic Patient Rights and Responsibilities 1. As a PRC patient, you have rights. You have the right to: Receive considerate and respectful care regardless of your race, gender,
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Start by providing your personal information including your name, address, and contact details.
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Next, provide your medical history including any past or present dental conditions, allergies, or medications you may be taking.
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Specify the reason for your visit, whether it is for a routine check-up, dental cleaning, or a specific dental concern.
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If you have dental insurance, provide the necessary insurance details for billing purposes.
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Finally, review all the information you have provided and make sure it is accurate before submitting the form.

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Piedmont Regional Dental Clinic is a dental clinic serving the Piedmont region.
All dental professionals practicing in the Piedmont region are required to file at the clinic.
You can fill out the Piedmont Regional Dental Clinic form online or in person at the clinic.
The purpose of Piedmont Regional Dental Clinic is to provide dental services to the community in the Piedmont region.
Information such as patient demographics, treatment provided, and insurance information must be reported on the clinic.
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