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Name: Address: Phone HM: Date of Birth: Employer: Emergency Contact:Work: Sex:Today date: Postal Code: Cell: Email Address: Occupation: Phone:Physician: Phone: Previous Dentist: Phone # Who can we
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Anyone who wants to join or access the services of Millennium Smile would need to fill out the 'welcome to millennium smile' form.
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Existing patients may also be asked to fill out this form for periodic updates or changes in their personal information.
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Welcome to millennium smile is a dental clinic focused on providing quality dental care to patients of all ages.
All new patients are required to fill out the welcome to millennium smile form upon their first visit to the clinic.
Patients can fill out the welcome to millennium smile form by providing their personal information, medical history, and any dental concerns they may have.
The purpose of the welcome to millennium smile form is to gather relevant information about the patient's health and dental history in order to provide personalized care.
Patients must report their personal information, medical history, current medications, allergies, and any dental concerns or issues.
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