Benjamin B. Ingram, DMD, P.C.

  Prior to your dental appointment for New patients, you can download and print the Patient Registration and Medical  History and bring to your Dental appointment. 

 If you are a current patient and you have any changes in medical, address change, name, or medications, You can     download and print both the forms for a update for our records. Bring to your next Dental appointment.

 

                                                      Patient Registration

                                                      Medical History  

                                                                            

                                     Forms may require Adobe Acrobat Reader to print forms.

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