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Receipt Form

 * Patient Name
No. Treatment Tooth Amount
 1  Consultation
 2  X-ray
 3  Scaling
 4  Preventive Treatment
 5  Restoration
 6  Root Canal Treatment
 7  Denture
 8  Crowns & Bridges
 9  Extraction
 10  Orthodontic Treatment
 11  Periodental Surgery
 12  Dentures
 13  Lumineers
 14  Cosmetic Bleaching
 15  Gummy Smiles
 16  Other

Secure Code

Dr. A. P. Kakade

 

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