Patient Health History Form - Two-Sided, Two Hole Punch #4046V Quantity:3000 COLORS: Your Company Heading is

COLORS: Your Company Heading is printed in Reflex Blue

1 side only

PDF TEMPLATE (5" x 7" / Mailing)

Signature line below ensures there are no misunderstandings

The Work Order 213 comes in a carbonless 2 or 3-part variation (last part is Manilla Tag Stock)

Patient Health History Form - Two-Sided, Two Hole Punch #4046V Quantity:3000 COLORS: Your Company Heading isHealth history questionnaire allows you to quickly obtain comprehensive dental & medical information. Double sided. Printed on 2 sides on white ledger stock. Simple checklist format. Forms use a series of questions designed to prompt responses through a simple checklist format. Includes: 2 hole punch with check off boxes. Easy to read. Dentist can quickly scan the completed form & identify problem "yes" areas to discuss with the patient. Size: 8 1 2 x