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D-4, r. 15 - Regulation respecting the keeping of records and consulting-rooms by denturologists

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SCHEDULE I
(s. 2.02)
NOTICE
□ I have been examined by a dentist for the purpose of receiving a service relating to a removable partial denture.
OR
□ I have not been examined by a dentist for the purpose of receiving a service relating to a removable partial denture, but I have been informed of the importance of such an examination.
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Initials or signature of client
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Date
O.C. 67-92, s. 3.
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