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COMPLEMENTARY PLAN
To provide Dental Health Care-Plan, please ensure you have the following available:
Panoramic 2D X-ray
less than 6 months old
(see image example below)
Do you know when you could have your first clinic visit?
Assuming you wish to proceed with the Care-Plan and to ensure we can accommodate your agenda, please confirm here if you already an estimated date(s) on when you could have your first clinic visit.
Yes
No
Date Option 1
DD/MM/YYYY
Date Option 2
DD/MM/YYYY
Date Option 3
DD/MM/YYYY
Example 2D Panoramic X-Ray