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PATIENT REGISTRATION FORM (PLEASE PRINT)MAIN FAMILY DENTAL CARE, PC 1905 Main Street Davenport, IA 52803 (563) 3232571 (563) 3231069 Fax www.mainfamilydentalcare.comDate Reason you are here today
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How to fill out main family dental care

01
Begin by gathering all necessary information and documents such as your personal identification, contact details, and insurance information.
02
Contact the main family dental care office either through phone or online to schedule an appointment.
03
Arrive at the dental office on the scheduled date and time.
04
Fill out the main family dental care form provided by the receptionist.
05
Provide accurate and detailed information regarding your medical history, current dental concerns, and any allergies or medications you are currently taking.
06
Review the completed form for any errors or missing information before submitting it.
07
Sign the form and return it to the receptionist.
08
Wait for your turn to meet the dentist.
09
During your dental appointment, the dentist will examine your oral health, perform any necessary treatments or procedures, and provide recommendations for further care.
10
Follow any instructions or recommendations given by the dentist for maintaining good oral health.
11
Make any necessary follow-up appointments or schedule future dental check-ups.
12
Keep a copy of the completed main family dental care form for your records.

Who needs main family dental care?

01
Main family dental care is recommended for individuals of all ages who require regular dental check-ups, preventive care, and treatment for common dental issues.
02
This includes children, adults, and seniors who need professional dental services such as teeth cleaning, cavity fillings, dental examinations, X-rays, fluoride treatments, dental sealants, extractions, and oral health education.
03
Even individuals with no specific dental problems can benefit from main family dental care by maintaining good oral health, preventing future issues, and receiving prompt treatment for any developing conditions.
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Main family dental care is a dental care plan that covers the entire family's dental needs.
The head of the household or the primary caretaker of the family is required to file main family dental care.
Main family dental care can be filled out online or in person with the assistance of a dental care provider.
The purpose of main family dental care is to ensure that the family members receive regular dental check-ups and treatments.
Main family dental care requires information about each family member's dental history, current dental issues, and insurance coverage.
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