X-Ray Form

* PATIENT INSTRUCTIONS *

1. Bring this Rx slip with you.
2. Please brush teeth, comb hair, and remove head & neck jewelry.
3. Remove non-permanent appliances such as retainers, partials, etc.
4. 24 hr. prior notice of cancellation is appreciated.
5. Patients more than 10 minutes late may have to be rescheduled.
6. PAYMENT IS REQUIRED AT TIME SERVICES ARE RENDERED.1. Bring this Rx slip with you.
7. Please brush teeth, comb hair, remove head & neck jewelry.
   
8. Remove non-permanent appliances such as retainers, partials, etc.
   
9. 24 hr. prior notice of cancellation is appreciated.
   
10. Patients more than 10 minutes late may have to be rescheduled.
    
11. PAYMENT IS REQUIRED AT TIME SERVICES ARE RENDERED.