Item Number 4065S (Replacement Item Number 4065) Capture personal data, insurance information, medical history and more with a colorful, patient-friendly form Size: 8 1/2 x 11 Durable forms 2-sided format 28 pound ledger stock Lined sheet accommodates up to 50 patient names and arrival times Available in English or Spanish 100 two-sided registration and history forms per pad
Ships direct from the plant in 48 hours or less
Additional Details
------------------------------
Product description: Item Number 4065S (Replacement Item Number 4065) Capture personal data, insurance information, medical history and more with a colorful, patient-friendly form Size: 8 1/2 x 11 Durable forms 2-sided format 28 pound ledger stock Lined sheet accommodates up to 50 patient names and arrival times Available in English or Spanish 100 two-sided registration and history forms per pad