Now carrying more than 1,000 Staples® brand products!
Select a practice type
  • Select a practice type
  • Medical
  • Dental
  • Chiropractic
  • Eye Care
  • Podiatry
  • Veterinary & Pet Care
  • Other
Spend only more, to get Free Delivery *
0
Items $0.00
Checkout

Show All Products

Need help? Contact us Need help? Contact us

Item # 174-20605   Model # 20605


$31.00
per Pack
When you buy 4+
Add to My List
250 EACH = 1 PACK
Buy more, save more!
$40.00
Buy 2$34.00
Buy 4+$31.00
( 1 )
Write a ReviewRead Reviews
100% of respondents would recommend this
Delivery time for
Your delivery dates will be verified at checkout

Form allows you to gather complete information from patients Simple to fill out with individually numbered sections Includes sections on patient information, insurance, history and more Head to toe dental registration and history form 2-sided form is printed top-to-bottom in purple ink on 24 lb. white bond paper 2-hole punched at the top 250 per package Size: 8-1/2x11"

Product Information
Form Type :
Clinical
Format :
Patient Registration Form
Sheet Size :
8-1/2" x 11"
Form Size :
8-1/2" x 11"
Media Quantity :
250
Binding Type :
Loose
Paper Color :
White
Number of Parts :
1
Carbonless :
No
# Up Per Sheet/Page :
1
NCR Paper :
No
Numbered :
No
Holes Punched :
None
Personalization :
No
Security Features :
No
Miscellaneous
Brand Name :
Medical Arts Press
Country of Origin :
USA
Weight
Weight :
3.02 lbs. per Pack

REVIEW SNAPSHOT®

by PowerReviews
Medical Arts Press® Dental Registration and History Form
 
5.0

(based on 1 review)

REVIEWS

Reviewed by 1 customer

Displaying review 1

Back to top

8/12/2009
 
5.0

Very Comprehensive

By fran

from CT

About Me Quality Oriented

Verified Buyer

Pros

  • Adequate Writing Space
  • Includes Necessary Fields
  • Organized Layout
  • Prevents Write-Through
  • Professional Design

Cons

    Best Uses

    • Internal Use
    • Professional Work

    Comments about Medical Arts Press® Dental Registration and History Form:

    WE needed new/updated info on all our patients as we are now scanning all paperwork into the system.

    • Primary use:
    • Business

    Bottom Line Yes, I would recommend this to a friend

    Was this review helpful? Yes / No

     - You may also flag this review

    Displaying review 1

    Back to top

    Description Price Unit Take Action
    Medical Arts Press® Dental Treatment Record Form; 2-Sided
    Medical Arts Press® Dental Treatment Record Form; 2-Sided

    174-20608

    		 $31.00
    When you buy 4+         		Pack
    Buy
    Medical Arts Press® Dental Treatment Consent Form; 1-Sided
    Medical Arts Press® Dental Treatment Consent Form; 1-Sided

    174-20606

    		 $28.00
    When you buy 4+         		Pack
    Buy
    Medical Arts Press® FormFamily Dental History Update Form
    Medical Arts Press® FormFamily Dental History Update Form

    174-20610

    		 $28.00
    When you buy 4+         		Pack
    Buy
    Medical Arts Press® FormFamily Dental Exam Form
    Medical Arts Press® FormFamily Dental Exam Form

    174-20609

    		 $28.00
    When you buy 4+         		Pack
    Buy
    Medical Arts Press® FormFamily Periodontal Exam Form
    Medical Arts Press® FormFamily Periodontal Exam Form

    174-20607

    		 $28.00
    When you buy 4+         		Pack
    Buy
    Description Price Unit Take Action
    Huge selection on filing supplies, forms and labels
    Privacy Policy
    We guarantee your privacy, our site's security and everything we sell. Learn more
    Questions
    Find answers to our most frequently asked questions.
    We’re here for you!
    Have a question or need help finding a product? Contact us for assistance from a representative.
    Back to top
    E-mail this to a friend Print this page
    My Account
    Order history / Tracking
    Software Downloads
    Item usage Report
    Make a return
    Invoice View
    Account Balance
    Message Center
    Help
    Specials
    New
    On Sale
    Clearance
    Rebate
    Free Samples
    Request a Catalog
    E-mail Sign Up
    Featured Categories
    Staples® Brand Products
    State RX Forms
    HIPAA Center
    Pulse of Your Practice
    Furniture Specialists
    Green Center
    Pink Products
    Practice Essentials - Blog
    Just for Kids
    Site Map
    About Medical Arts Press
    Medical Arts Press History
    Pricing Policy
    Privacy & Security
    Order Restrictions
    Online Tools
    Catalog Quick Order
    My Lists
    Rapid Reorder
    Recreate an Order
    Ink & Toner Finder
    Shredder Finder
    Printer Finder
    Paper Finder
    Filing Finder
    Software Demo
    Visit us at
    Facebook
    Twitter
    RSS

    ©2012 Medical Arts Press® All rights reserved. Questions? E-mail or call us toll-free, 1-800-328-2179.

    Click to verify BBB accreditation and to see a BBB report

    loading Loading...