https://www.staples-3p.com/s7/is/image/Staples/s0948967_sc7
Medical Arts Press Dental Registration and Medical History Form, Spanish (20586)
$24.91
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Medical Arts Press Dental Registration and Medical History Form, Spanish (20586)~#|#~s0948967_sc7
Medical Arts Press Dental Registration and Medical History Form, Spanish (20586)~#|#~s0948968_sc7
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  • Type of form: Dental registration and medical history form
  • 250 per pack
  • Size: 8 1/2" x 11"

Medical Arts Press Dental Registration and Medical History Form, Spanish (20586)

Item #: 540806Model #: 20586
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250/pack
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    • Details

    About this product

    Obtains a medical history and personal, financial and insurance info. Has special sections for Parent info., insurance authorization, and 2 Medical History Updates. Printed in Spanish on 20-lb. bond. 250 sheets per package. Size: 8-1/2x11".

    • Type of form: Dental registration and medical history form
    • 250 per pack
    • Size: 8 1/2" x 11"
    • Paper weight: 24 lbs.
    • Binding type: Loose
    • Number of parts: 1
    • Obtains a medical history and personal, financial and insurance info
    • Has special sections for parent info
    • Insurance authorization and 2 medical history updates
    • Printed on 24 lbs. white ledger stock

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    Specifications
    Specifications table
    Attribute nameAttribute value
    Length in Inches 11
    Form Size
    		8 1/2" x 11"
    Medical Form Type Dental Claims
    Width in Inches
    		8.5
    Medical Form Pack Size 250
    True Color
    		White
    Print Type Continuous
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    Delivery Information
    Delivery by Thu, Apr 24
    Delivery by Thu, Apr 24
    Free delivery by Thu, Apr 24
    Delivery by Thu, Apr 24
    Delivery by Mon, Apr 28
    Delivery by Thu, Apr 24
    Free delivery by Thu, Apr 24
    Delivery by Thu, Apr 24
    Available in my store
    No
    No
    No
    No
    No
    No
    No
    No
    Length in Inches
    11
    11
    11
    17
    11
    11
    11
    11
    Form Size
    8 1 / 2" x 11"
    8 1 / 2" x 11"
    8 1 / 2" x 11"
    11" x 17"
    8 1 / 2" x 11"
    8 1 / 2" x 11"
    8 1 / 2" x 11"
    8 1 / 2" x 11"
    Width in Inches
    8.5
    8.5
    8.5
    11
    8.5
    8.5
    8.5
    8.5
    Medical Form Pack Size
    250
    100
    250
    100
    200
    250
    250
    250
    True Color
    White
    White
    White
    Data not available
    White
    Data not available
    White
    White
    Medical Form Type
    Dental Claims
    Medical Records Folders
    Data not available
    Privacy Practice
    Privacy Practice
    Privacy Practice
    Data not available
    Data not available
    Print Type
    Continuous
    Continuous
    Data not available
    Data not available
    Data not available
    Continuous
    Data not available
    Data not available
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