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Root Canal Specialists Practice Limited to EndodonticsWelcome Patient Information Date___ Home Phone___ Cell Phone___ Name___ Soc. Sec #___ Last NameFirst NameInitialAddress___ City___ State___ Zip___

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Gather all necessary documents such as identification, insurance card, and any previous medical records.

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Medical history - root is a comprehensive record of a patient's medical information including past illnesses, surgeries, medications, allergies, and family medical history.

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