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REFERRAL SLIPS

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Referred by Dr.

Introducing My Patient

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Please Evaluate For Early or Interceptive Treatment
Please Evaluate For Full Orthodontics
Please Evaluate For Craniofacial Orthodontics
Pre-prosthetic Treatment Needed
Please Evaluate For TMD Treatment
Please Evaluate For Orthogentic Surgery
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I Have Sent Radiographs For Your Evaluation

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