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Please take a moment to complete this short form before your visit.

1. What brings you to consult with Dr. Tremblay today?

2. Is this your first or second consultation?

3. Are you considering a replacement for one tooth, several teeth, or a full-mouth restoration?

4. If you have missing teeth, how long ago were they removed?

Do you already have a panoramic X-ray?

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Attach your radiograph (if available):