Practice Marketing & Office Supply Catalog 2021/2022 - 146

CLINICAL FORMS

EXAM & RECORD FORMS

Back

Back

Front
Front

EXAM/ACCOUNT RECORD FORM

*	 Front of this 2-sided form features " 1-32 " numbering, " a-t " lettering, and
an area to summarize patient history
*	 Back side has space to list services needed or rendered and fees
*	 Printed on sturdy ledger stock
*	 81⁄2 " x 101⁄2 " horizontal
(367-3430)�����������������������������������������������������������250 per Pkg.
53.99

(369-0034) Opaque Stock

GEOMETRIC EXAM RECORD FORM

*	 Front has tooth charts as shown, with an area for clinical data and
medical/dental history summaries
*	 Back has space for necessary services and their fees
*	 81⁄2 " x 11 " horizontal
(367-9820)�����������������������������������������������������������250 per Pkg.

53.99

Front

CLINICAL PATIENT CHARTS

*	 Letter-size chart allows for plenty of space to record comprehensive,
permanent patient records
*	 2-sided form includes room for clinical findings, patient histories, and charge
information, among others
*	 Printed with green ink on 80 Lb. offset opaque stock or heavy-duty, 110 Lb.
index card stock
*	 81⁄2 " W x 11 " H
80 Lb. Opaque Stock

(369-0034) �������������������������������������������������������������100 per Pkg.



5 Pkg.@

22.99
20.99
Back

146

To order, visit: www.henryscheindental.com

http://www.henryschein.com/redirect.aspx?did=specialmarkets_m&returnurl=/us-en/Shopping/ProductDetails.aspx%3Fproductid%3D3679820%26CatalogName%3DPRIME%26utm_source%3DSpecialMarkets%26utm_medium%3DNxtbook%26utm_campaign%3Dpracticemarketing20212022-sm%26utm_term%3D3679820 http://www.henryschein.com/redirect.aspx?did=specialmarkets_m&returnurl=/us-en/Shopping/ProductDetails.aspx%3Fproductid%3D3673430%26CatalogName%3DPRIME%26utm_source%3DSpecialMarkets%26utm_medium%3DNxtbook%26utm_campaign%3Dpracticemarketing20212022-sm%26utm_term%3D3673430 http://www.henryschein.com/redirect.aspx?did=specialmarkets_m&returnurl=/us-en/Shopping/ProductDetails.aspx%3Fproductid%3D3690034%26CatalogName%3DPRIME%26utm_source%3DSpecialMarkets%26utm_medium%3DNxtbook%26utm_campaign%3Dpracticemarketing20212022-sm%26utm_term%3D3690034 http://www.henryschein.com/redirect.aspx?did=specialmarkets_m&returnurl=/us-en/Shopping/ProductDetails.aspx%3Fproductid%3D3690034%26CatalogName%3DPRIME%26utm_source%3DSpecialMarkets%26utm_medium%3DNxtbook%26utm_campaign%3Dpracticemarketing20212022-sm%26utm_term%3D3690034 http://www.henryscheindental.com

Practice Marketing & Office Supply Catalog 2021/2022

Table of Contents for the Digital Edition of Practice Marketing & Office Supply Catalog 2021/2022