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South Lake Tahoe Casino Shows

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DENTAL CLEARANCE FORM PLEASE HAVE YOUR DENTIST COMPLETE ALL SECTIONS OF THIS FORM AND FAX IT TO 216 445 9608 If you have had your teeth removed wear Patient: DOB: ______. Dear Dr. ,. Our mutual patient,. , is scheduled for dental treatment. Treatment may include: _____ Cleaning (simple or deep).

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MEDICAL CLEARANCE FOR DENTAL TREATMENT Date Attention Patient Name Date of Dentist Name Please Print Dentist Signature Date Physicians Please Lake Tahoe Lodging Places To Stay In Lake Tahoe Hotels More

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