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SCRUGGS & MOLINA7201 Creed moor Road, Suite 120PROSTHODONTICSRaleigh, NC 27613 Phone (919) 846 6622 / Fax (919) 846 8012PATIENT MEDICAL HISTORY Patients Name Date / / MaleFemaleMarriedSingleMinor

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1. To fill out Scruggs & Molina form, follow these steps:
2. Start by obtaining the form from the official website of Scruggs & Molina or from their physical office.
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5. Begin filling out the form by entering your personal details such as your full name, address, contact information, etc.
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10. Make a copy of the completed form for your records, and then submit the original form along with any required supporting documents to Scruggs & Molina through their preferred method of submission, such as by mail, email, or in person.
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