CLINICAL FORMS CLINICAL FORMS Exam & Record Forms DENTAL CHARTING SYSTEM • Preassembled folder and forms contain all the necessary forms a dental office needs and cost much less than purchasing each component separately • Includes a durable 11 pt. manila pocket folder with a 2” bonded fastener in position 3 • Also included are a file divider with one twin prong fastener, and a 5-mil poly pocket measuring 81⁄2”W x 51⁄2”H • Each folder comes complete with each of the 8 clinical forms featured below • Individual clinical forms can also be purchased separately Description Qty. Price 2@ 5@ A. Preassembled Chart 25/PK $58.99 $57.99 $55.99 with 8 Clinical Forms B–I. Individual Clinical Forms 100/PK $18.79 $15.79 $13.79 A. 367-1163 B D E C PATIENT REGISTRATION 367-1054 PROGRESS NOTES 2-Sided 367-1057 RECALL EXAMINATION 367-1056 HEALTH HISTORY UPDATE 367-1058 F H G CORRESPONDENCE LOG 367-1059 TREATMENT PLAN WITH CHART 367-1061 CLINICAL EXAMINATION 367-1060 130 www.henryscheindental.com HEALTH HISTORY 2-Sided 367-1062http://www.henryschein.com/redirect.aspx?did=dental&returnurl=/us-en/Shopping/ProductDetails.aspx%3Fproductid%3D3671163%26CatalogName%3DDENTAL http://www.henryschein.com/redirect.aspx?did=dental&returnurl=/us-en/Shopping/ProductDetails.aspx%3Fproductid%3D3671054%26CatalogName%3DDENTAL http://www.henryschein.com/redirect.aspx?did=dental&returnurl=/us-en/Shopping/ProductDetails.aspx%3Fproductid%3D3671057%26CatalogName%3DDENTAL http://www.henryschein.com/redirect.aspx?did=dental&returnurl=/us-en/Shopping/ProductDetails.aspx%3Fproductid%3D3671056%26CatalogName%3DDENTAL http://www.henryschein.com/redirect.aspx?did=dental&returnurl=/us-en/Shopping/ProductDetails.aspx%3Fproductid%3D3671058%26CatalogName%3DDENTAL http://www.henryschein.com/redirect.aspx?did=dental&returnurl=/us-en/Shopping/ProductDetails.aspx%3Fproductid%3D3671059%26CatalogName%3DDENTAL http://www.henryschein.com/redirect.aspx?did=dental&returnurl=/us-en/Shopping/ProductDetails.aspx%3Fproductid%3D3671061%26CatalogName%3DDENTAL http://www.henryschein.com/redirect.aspx?did=dental&returnurl=/us-en/Shopping/ProductDetails.aspx%3Fproductid%3D3671060%26CatalogName%3DDENTAL http://www.henryschein.com/redirect.aspx?did=dental&returnurl=/us-en/Shopping/ProductDetails.aspx%3Fproductid%3D3671062%26CatalogName%3DDENTAL http://www.henryscheindental.com