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Page 1: orthodontistandbracesinoc.com...Orthodontist Braces in Orange County Age Today's Date. Child's Name Address: Tel Email: School: CHILD'S INFORMATION Birthdate. Social Security # Grade

Page 2: orthodontistandbracesinoc.com...Orthodontist Braces in Orange County Age Today's Date. Child's Name Address: Tel Email: School: CHILD'S INFORMATION Birthdate. Social Security # Grade

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· 2020-05-27 · photographs and clinical records regarding my child's dental health to another facility/physician, such as my pediatrician or orthodontist. No I understand that