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ADULT ORTHODONTIC ACQUAINTANCE FORM Date Demographic Information Name (Mr., Ms., Mrs, Dr.) Name you would like to be called Age Birth date Social Security Number Sex (Circle one) Address StreetCityPhone
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What is orthodontic acquaintance form?
The orthodontic acquaintance form is a document that provides information about a patient's orthodontic treatment and is typically completed by the orthodontist.
Who is required to file orthodontic acquaintance form?
The orthodontist is required to file the orthodontic acquaintance form.
How to fill out orthodontic acquaintance form?
To fill out the orthodontic acquaintance form, the orthodontist must provide details about the patient's treatment, including type of treatment, progress, and any other relevant information.
What is the purpose of orthodontic acquaintance form?
The purpose of the orthodontic acquaintance form is to keep a record of the patient's orthodontic treatment and progress.
What information must be reported on orthodontic acquaintance form?
The orthodontic acquaintance form must include details about the patient's treatment plan, progress, any issues or complications, and any additional relevant information.
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