{"product_id":"form-100-17-patient-information-form","title":"Form 100-17 - Patient Information Form","description":"\u003cp\u003eLarge Print, Expanded Patient Information, Terms and Conditions, Health Questionnaire and Consent Large print, easy to read version of our 100-6 includes expanded information\u003cbr\u003eFinancial and Insurance information\u003cbr\u003eTerms and Conditions\u003cbr\u003eMedical History\u003cbr\u003eDental History\u003cbr\u003eConsent for Treatment\u003cbr\u003eGood for 3 years of updates\u003cbr\u003ePatient reviews health history, lists changes, then dates and signs\u003cbr\u003eSize 11” x 17”, folds to 8.5 x 11\"\u003cbr\u003ePrinted 2 sides black and teal ink on white stock\u003cbr\u003e100 per package.\u003c\/p\u003e","brand":"4 Dental Docs","offers":[{"title":"Default Title","offer_id":48330047684866,"sku":null,"price":59.0,"currency_code":"USD","in_stock":true}],"thumbnail_url":"\/\/cdn.shopify.com\/s\/files\/1\/0825\/9908\/4290\/files\/100-17.jpg?v=1786635049","url":"https:\/\/4dentaldocs.com\/products\/form-100-17-patient-information-form","provider":"4 Dental Docs","version":"1.0","type":"link"}