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Rockingham Pediatric DentalCONFIDENTIAL32 Stiles Rd. Suite 207 Salem, NH 03079 Phone 6038988611Patient Information Child's Name: Preferred/Nickname: Gender: Male Female Birthdate: School: Address:
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To fill out the Rockingham Pediatric Dental form, follow these steps:
02
- Start by downloading the form from the official website or visit the dental clinic to obtain a printed copy.
03
- Fill in your personal information such as your full name, date of birth, address, and contact details.
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- Provide your insurance information including the name of your insurance company, policy number, and group number.
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- Indicate any specific dental concerns or conditions you or your child may have.
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- Answer the medical history questions accurately, including any allergies or current medications.
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- If you have a referring dentist, provide their name and contact information.
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- Read and understand the terms and conditions of the consent form before signing and dating it.
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- Make sure all the sections are filled out correctly and legibly.
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- Double-check your entries for any mistakes or missing information.
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- Submit the completed form by either returning it to the dental clinic in person or mailing it to the provided address.
Who needs rockingham pediatric dental?
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Rockingham Pediatric Dental is suitable for children and teenagers who require dental care and treatment. It specifically caters to the dental needs of pediatric patients, which includes infants, toddlers, children, and adolescents up to the age of 18. Parents or guardians seeking specialized dental services and a child-friendly environment for their kids can benefit from Rockingham Pediatric Dental.
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What is rockingham pediatric dental?
Rockingham Pediatric Dental is a pediatric dental practice located in Rockingham, specializing in dental care for children.
Who is required to file rockingham pediatric dental?
Parents or guardians of children receiving dental care at Rockingham Pediatric Dental are required to file forms for insurance and billing purposes.
How to fill out rockingham pediatric dental?
To fill out Rockingham Pediatric Dental forms, parents or guardians must provide accurate information about the child's dental history, insurance coverage, and contact details.
What is the purpose of rockingham pediatric dental?
The purpose of Rockingham Pediatric Dental is to provide high-quality dental care for children in the Rockingham area, promoting good oral health habits from a young age.
What information must be reported on rockingham pediatric dental?
Information such as the child's name, date of birth, insurance information, medical history, and contact information must be reported on Rockingham Pediatric Dental forms.
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