Fernando J. Meza, DMD, PLLC

H. Vivian Lee, DDS 

Loken M. Patel, DMD


 

P R A C T I C E   L I M I T E D   T O   E N D O D O N T I C S

 

 

 

 

703.370.1327

 

Alexandria Professional Center

4660 Kenmore Ave. Suite 700

Alexandria, VA  22304

     Patient -  Forms

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        We request our patients to fill out the following forms before we start any treatment.  You may fill  these forms prior   to arriving for your appointment by printing, filling out and bringing them with  you.

 

-         Patient Information

          Medical History

          Consent Form

          Financial Policy

           

       Forms in Spanish

    

          Información del Paciente

          Historia Médica

          Consentimiento para tratamiento de Endodoncia


 You will need Adobe Reader to open these form.  Please download it here, if you don't have it on  your computer.
 

 
 

 

 

 

 

 

 

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