€¦ · history health . patient dental history patient's name reason for this visit when was...

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Page 1: €¦ · history health . patient dental history patient's name reason for this visit when was your last dental visit ... do you wear dentures or partials . if yes, date of placement
Page 2: €¦ · history health . patient dental history patient's name reason for this visit when was your last dental visit ... do you wear dentures or partials . if yes, date of placement