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Forms for your Practice

The forms on this page are downloadable in a pdf form.  They are also available in an editable word doc form by contacting the Fifth District at [email protected] or 315-434-9161.

HIPAA Model Notice of Privacy Practices New
General Dentistry Informed Consent Form
Consent Form For Surgery
Informed Refusal of Treatment
Jury Excuse Letter
Patient Dismissal Form Letter
Patient Insurance Benefits Claims

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