Directory Results for Patient Registration and Dental History Patient Ination Patient Name Date of Birth Social Security # Marital Status Patient Address City, State, Zip Home Phone Work Phone Email address Cell Phone Emergency Contact Name and Number What to Patient Registration and Dental/Medical History Patient Information Childs Full Name Nickname Birth Date: Sex: M F Child Lives with Both Parents Mother Father Other: Siblings (Names and Ages) Childs Favorite Sport/Activity/Hobby School