• Child New Patient Information & History

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  • Health Care Professional(s)

  • Dental Insurance Information

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  • Pediatric Sleep Questionnaire: Sleep-Disordered Breathing Subscale

    Please answer these questions regarding the behavior of your child during sleep and wakefulness. The questions apply to how your child acts in general during the past month.
  • Notice of Privacy Practices

  • Health Information Access

    Note: If you wish to add or teminate information access to or from the list below, you must submit your request in writing to our office.
  • Signature

  • Clear
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  • Should be Empty: