Download Dr - Somerset Orthodontic Specialists

Survey
yes no Was this document useful for you?
   Thank you for your participation!

* Your assessment is very important for improving the work of artificial intelligence, which forms the content of this project

Document related concepts
no text concepts found
Transcript 
Dr. Robert Peterman
Somerset Orthodontic Specialists, LLC
Certificate of Dental Cleaning
________________________________________________________
PATIENT NAME
I am a patient of Dr. Peterman and I can earn Wooden
Nickels through the “Wooden Nickel Program” for having a visit
with you for a cleaning and checkup with good brushing and no
cavities. Bringing in this certificate at my next orthodontic
appointment guarantees me 4 Wooden Nickels!
Thank you for completing this certificate.
This certifies that the patient above has completed the
following:
(Please circle all that apply)
Dental Exam
Dentist Initials: ____________
Routine Cleaning
No Cavities
Appointment Date:__________
Somerset Orthodontic Specialists, LLC
199 W. High Street, Somerville, NJ 08876
908-526-0039
www.somersetorthospecialists.com
Related documents