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Dental Registration Form
Specify:
Ethnic group:
Is transport clinically necessary:
Religion:
(All requests for transport will be reassessed at the point of
booking according to DoH criteria and may be declined)
REFERRAL INFORMATION
Diagnosis/Reason for referral:
(please include current symptoms, relevant history and details of any diagnostic tests)
Medication:
Allergies:
Referrer signature:
To submit this referral form please fax back to 01424...
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Instructions and help about dental registration forms
FAQs dental registration
-
How do I fill out the ICSI registration form?
Online Registration for CS Foundation | Executive | ProfessionalCheck this site -
I have created a registration form in HTML. When someone fills it out, how do I get the filled out form sent to my email?
Are you assuming that the browser will send the email? That is not the way it is typically done. You include in your registration form a and use PHP or whatever on the server to send the email. In PHP it is PHP: mail - Manual But if you are already on the server it seems illogical to send an email. Just register the user immediately.
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