Patient Registration Form

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The following information is required to enable us to provide you with the best possible dental care. All information is strictly private, and is protected by doctor-patient confidentiality. The dentist will review the questions and explain any that you do not understand. Please fill out the entire form.


I hereby certify the above to be true to the best of my knowledge. If I ever have changes to my health or if my medications change, I will inform the dentist at my next visit

Email/Text Permission

Sky Dental has my consent to contact me using text/email according to my preferences listed above.

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