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CO₂LLABORATIVE CARE AND RESEARCH

ASSESSMENT + CARE REFERRAL

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REFERRAL FORM

CO₂LLABORATIVE CARE + RESEARCH

ASSESSMENT + CARE REFERRAL

PLEASE FILL OUT THE FOLLOWING INFORMATION ABOUT YOUR PATIENT

Gender
Does the patient have any historical scans, panoramic, cephalometric, or dental x-rays? If yes, please upload below or email to welcome@co2llab.care
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