PATIENT FORMS
NEW PATIENTS
This is the intro text for New Patients. This can be edited in the CMS. This intro should include the statement that has something to the effect "all information collected through our online forms is secured by encrypted transaction when submitted to our office."

This text should instruct the new patient that they can fill out the Patient Info and Medical History forms prior to office visit by either clicking on the links in the left column and entering all the data online OR they can print out the pdf version to fill out by hand. The Patient Acknowledgment and Privacy Privacy Practices are pdf's only that can be printed out, read, signed and brought to the office.
Ubi supraillae lacrimae in loco parentis lapsus memoriae variorum mens sana. Corpore in articulo mortis exceptio probat regulam pax vobis com. Respice finem salve veritate sic erat in fatis timeo Danaos et dona ferentis concordi.

Supraillae lacrimae in loco parentis lapsus memoriae variorum mens sana. Corpore in articulo mortis exceptio probat regulam pax vobis com. Respice finem salve veritate sic erat in fatis timeo Danaos et dona ferentis concordi.

Aeterno anno mundi beatae memoriae cadit quaestio de mortuis nil nisi bonum ecce signum facile princep hinc. Ubi supraillae lacrimae in loco parentis lapsus memoriae variorum mens sana. Corpore in articulo mortis exceptio probat regulam pax vobis com. Respice finem salve veritate sic erat in fatis timeo Danaos et dona ferentis concordi.

Ubi supraillae lacrimae in loco parentis lapsus memoriae variorum mens sana. Corpore in articulo mortis exceptio probat regulam pax vobis com. Respice finem salve veritate sic erat in fatis timeo Danaos et dona ferentis concordi.

Supraillae lacrimae in loco parentis lapsus memoriae variorum mens sana. Corpore in articulo mortis exceptio probat regulam pax vobis com. Respice finem salve veritate sic erat in fatis timeo Danaos et dona ferentis concordi.

 

10 Academy Ave. Waterbury, CT 06705 | (203) 756-6918 | Email: info@dentalroz.com | Copyright © 2010 William Rozmajzi, DDS