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Dr. Daniel Stegall€¦ · Notes 5. DENTAL HISTORY Reason for today's visit Former Dentist Last Cleaning State Email Date Fax: 972.499.7740 Please Continue to 2nd Page Signature Last

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Page 1: Dr. Daniel Stegall€¦ · Notes 5. DENTAL HISTORY Reason for today's visit Former Dentist Last Cleaning State Email Date Fax: 972.499.7740 Please Continue to 2nd Page Signature Last

Daniel Stegall

Dr. Daniel Stegall

Page 2: Dr. Daniel Stegall€¦ · Notes 5. DENTAL HISTORY Reason for today's visit Former Dentist Last Cleaning State Email Date Fax: 972.499.7740 Please Continue to 2nd Page Signature Last

Page 3: Dr. Daniel Stegall€¦ · Notes 5. DENTAL HISTORY Reason for today's visit Former Dentist Last Cleaning State Email Date Fax: 972.499.7740 Please Continue to 2nd Page Signature Last

Page 4: Dr. Daniel Stegall€¦ · Notes 5. DENTAL HISTORY Reason for today's visit Former Dentist Last Cleaning State Email Date Fax: 972.499.7740 Please Continue to 2nd Page Signature Last

Page 5: Dr. Daniel Stegall€¦ · Notes 5. DENTAL HISTORY Reason for today's visit Former Dentist Last Cleaning State Email Date Fax: 972.499.7740 Please Continue to 2nd Page Signature Last

Page 6: Dr. Daniel Stegall€¦ · Notes 5. DENTAL HISTORY Reason for today's visit Former Dentist Last Cleaning State Email Date Fax: 972.499.7740 Please Continue to 2nd Page Signature Last

Page 7: Dr. Daniel Stegall€¦ · Notes 5. DENTAL HISTORY Reason for today's visit Former Dentist Last Cleaning State Email Date Fax: 972.499.7740 Please Continue to 2nd Page Signature Last

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