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Organization: Internet Archive
The Internet Archive discovers and captures web pages through many different web crawls. At any given time several distinct crawls are running, some for months, and some every day or longer. View the web archive through the Wayback Machine.
Collection: Wide Crawl Number 15: Started Oct 1st, 2016 - Ended May 8th, 2017
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      • Bahram Ghassemi, D.M.D., M.Sc.D.
      • Sara Ghassemi, D.M.D.
      • Azin Tarifard, D.D.S.
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Patient Forms

For your convenience, New Patient Forms are available here for download for you to fill out and bring with you to your first appointment.

pdf Adult Patient History Form
pdf Children’s Patient History Form
pdf Notice of Privacy Practices
pdf Receipt of HIPAA

 

These documents are in Adobe PDF format. If you’re unable to read PDF files, please download free Adobe Acrobat Reader here.

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    • Bahram Ghassemi D.M.D., M.Sc.D.
    • Sara Ghassemi, D.M.D.
    • Azin Tarifard, D.D.S.
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  • Bahram Ghassemi, D.M.D., M.Sc.D.
  • Sara Ghassemi, D.M.D.
  • Azin Tarifard, D.D.S.
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