Common use of APPOINTMENT INFORMATION Clause in Contracts

APPOINTMENT INFORMATION. YOU MUST TAKE THIS PRESCRIPTION FORM WITH YOU WHEN YOU GO TO YOUR AP-POINTMENT. ADDRESS: PHONE: TREATMENT OBJECTIVE: Surgical Extraction ANATOMY TO SCAN: ▢ MAXILLA ▢ MANDIBLE ▢ BOTH ▢ QUADRANT ▢ TMJ DIAGNOSTIC OBJECITVE: ▢ IMPLANT IMAGING ▢ PATHOLOGY ▢ ENDODONTIC EVALUATION ▢ SINUS EVALUATION ▢ ORTHODONTICS ▢ TEETH/QUADRANT/ARCH OTHER INSTRUCTIONS:

APPOINTMENT INFORMATION. YOU MUST TAKE THIS PRESCRIPTION FORM WITH YOU WHEN YOU GO TO YOUR AP-POINTMENT. ADDRESS: PHONE: TREATMENT OBJECTIVE: Surgical Simple Extraction ANATOMY TO SCAN: ▢ MAXILLA ▢ MANDIBLE ▢ BOTH ▢ QUADRANT ▢ TMJ DIAGNOSTIC OBJECITVE: ▢ IMPLANT IMAGING ▢ PATHOLOGY ▢ ENDODONTIC EVALUATION ▢ SINUS EVALUATION ▢ ORTHODONTICS ▢ TEETH/QUADRANT/ARCH OTHER INSTRUCTIONS:

APPOINTMENT INFORMATION. YOU MUST TAKE THIS PRESCRIPTION FORM WITH YOU WHEN YOU GO TO YOUR AP-POINTMENT. ADDRESS: PHONE: TREATMENT OBJECTIVE: Surgical Extraction Molar Endo ANATOMY TO SCAN: ▢ MAXILLA ▢ MANDIBLE ▢ BOTH ▢ QUADRANT ▢ TMJ DIAGNOSTIC OBJECITVE: ▢ IMPLANT IMAGING ▢ PATHOLOGY ▢ ENDODONTIC EVALUATION ▢ SINUS EVALUATION ▢ ORTHODONTICS ▢ TEETH/QUADRANT/ARCH OTHER INSTRUCTIONS:

APPOINTMENT INFORMATION. YOU MUST TAKE THIS PRESCRIPTION FORM WITH YOU WHEN YOU GO TO YOUR AP-POINTMENT. ADDRESS: PHONE: TREATMENT OBJECTIVE: Surgical Extraction PreMolar Endo ANATOMY TO SCAN: ▢ MAXILLA ▢ MANDIBLE ▢ BOTH ▢ QUADRANT ▢ TMJ DIAGNOSTIC OBJECITVE: ▢ IMPLANT IMAGING ▢ PATHOLOGY ▢ ENDODONTIC EVALUATION ▢ SINUS EVALUATION ▢ ORTHODONTICS ▢ TEETH/QUADRANT/ARCH OTHER INSTRUCTIONS: