CLINICAL FORMS EXAM & RECORD FORMS Back Back Front Front EXAM/ACCOUNT RECORD FORM * Front of this 2-sided form features " 1-32 " numbering, " a-t " lettering, and an area to summarize patient history * Back side has space to list services needed or rendered and fees * Printed on sturdy ledger stock * 81 ⁄2 " x 101 ⁄2 " horizontal (367-3430)250 per Pkg GEOMETRIC EXAM RECORD FORM * Front has tooth charts as shown, with an area for clinical data and medical/dental history summaries * Back has space for necessary services and their fees * 81 ⁄2 " x 11 " horizontal (367-9820)250 per Pkg (369-0034) Opaque Stock Front CLINICAL PATIENT CHARTS * Letter-size chart allows for plenty of space to record comprehensive, permanent patient records * 2-sided form includes room for clinical findings, patient histories, and charge information, among others * Printed with green ink on 80 Lb offset opaque stock or heavy-duty, 110 Lb index card stock * 81 ⁄2 " W x 11 " H 80 Lb Opaque Stock (369-0034)100 per Pkg 5 Pkg@ Back 148 For pricing information and/or to place an order, visit: www.henryscheindental.comhttp://www.henryschein.com/redirect.aspx?did=dental&returnurl=/us-en/Shopping/ProductDetails.aspx?productid=3679820&CatalogName=DENTAL&utm_source=Dental&utm_medium=Nxtbook&utm_campaign=practicemarketing20222023&utm_term=3679820 http://www.henryschein.com/redirect.aspx?did=dental&returnurl=/us-en/Shopping/ProductDetails.aspx?productid=3673430&CatalogName=DENTAL&utm_source=Dental&utm_medium=Nxtbook&utm_campaign=practicemarketing20222023&utm_term=3673430 http://www.henryschein.com/redirect.aspx?did=dental&returnurl=/us-en/Shopping/ProductDetails.aspx?productid=3690034&CatalogName=DENTAL&utm_source=Dental&utm_medium=Nxtbook&utm_campaign=practicemarketing20222023&utm_term=3690034 http://www.henryschein.com/redirect.aspx?did=dental&returnurl=/us-en/Shopping/ProductDetails.aspx?productid=3690034&CatalogName=DENTAL&utm_source=Dental&utm_medium=Nxtbook&utm_campaign=practicemarketing20222023&utm_term=3690034 http://www.henryscheindental.com