Dental Form - Great Neck Public Schools

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GREAT NECK PUBLIC SCHOOLS
Health Services
Dental Health Report
Date________________________
Teacher’s Name __________________________________
This is to certify that __________________________________________________________________
____________Is under my care for dental treatment
____________Has completed dental treatment
__________________________________
Signature of Dentist
__________________________________
Address
 This report should be returned to the school nurse.
105Dentalal.doc
11/13

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