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Referrals
Refer Dr. Jamie Sahouria
Introducing Patient
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Date of birth
Parent Name
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Parent Phone
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Reason for referral
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Child is in pain
Child is frightened/uncooperative
May need sedation or general anesthesia
Completed cleaning & flouride treatment
X-rays have already, or will be emailed
No x-rays taken
Remarks
Referring Doctor
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Office Phone
Email
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