• Your child is scheduled to have the one or more of the following services rendered: Oral Examination, Dental Prophylaxis/Cleaning, Intraoral X-rays, and/or Fluoride Application.
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  • If you choose to decline topical fluoride / varnish and / or diagnostic dental x-rays, you will need to notify the office while checking in for your appointment.

  • This field is for validation purposes and should be left unchanged.