Dental Front Office Source - July 9–July 27, 2012 - (Page 32)

patient registration & statement paper PATIENT SIGN-IN & REGISTRATION B We Accept STATEMENT PAPER Please see back of form We Accept ® Please see back of form SM 1 3 SAVE UP TO $6.00 HIPAA PRIVACY SIGN-IN SHEETS Salmon (367-1043-K6) Blue (367-1044-K6) Green (367-1045-K6) 2 • Removable strip protects patient privacy • Carbon sheet transfers names to the back sheet • Available in 3 different colors Description Qty. Price 1-Sided, 81⁄2”W x 11”H 250/PK $63.99 Adult $62.99 2@ $60.99 (367-1095-K6) C 1 2 5@ SAVE UP TO $8.00 3 Compatible Compatible B–C. LASER STATEMENT PAPER ADULT REGISTRATION FORMS Child (366-0642-K6) • Specially designed forms display the Visa, MasterCard, and Discover logos to encourage prompt payment • Use with your Dentrix, Easy Dental, EagleSoft, Excaliber, and Softdent software • Features convenient detachable remittance stub perforated 35⁄8" from the top • All patient information is printed by your software package • Laser Paper Size: 81⁄2"W x 11"H, Continuous Paper Size: 91⁄2”W x 7”H B.1 B.2 B.3 C.1 C.2 C.3 Item # 366-6615-K6 366-4680-K6 366-7952-K6 134-5504-K6 134-5522-K6 134-6350-K6 Description Blue Pink Lt. Blue Blue, Laser Burgundy, Laser Blue, Continuous Qty. 500/PK 500/PK 500/PK 3000/PK 3000/PK 3000/PK • Comprehensive, full-color forms warmly welcome patients to your office • Forms are updated regularly to provide you, the provider, a thorough understanding of the adult patient’s dental and medical history • Features complete insurance information with a signature for assignment benefits • Allergy section covers drugs as well as latex and metals Description Qty. Price 3@ 5@ 2-Sided Form 100/PK $40.99 $37.99 $34.99 $33.29 $33.29 $33.29 $72.99 $73.99 $84.99 Price $31.29 $31.29 $31.29 $67.99 $68.99 $79.99 2@ $29.29 $29.29 $29.29 $62.99 $63.99 $73.99 5@ 32 Fax Your Order: 1.800.732.7023 24 Hours

Table of Contents for the Digital Edition of Dental Front Office Source - July 9–July 27, 2012

Dental Front Office Source - July 9–July 27, 2012
Table of Contents
Appointment Books
Appointment Cards
Filing Supplies
Dentrix eServices
Likeable Dentist
Lip Balms
Patient Bags
Patient Education
Pink Ribbon Items
Recall Cards
Treasure Chests
Zip-Close Pouches

Dental Front Office Source - July 9–July 27, 2012