Dr. Peter V. Lecca, D.D.S.

TMJ Therapy
Cosmetic & Restorative Dentistry


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Instructions:	Please print the following form. Read carefully, sign where necessary. Remember to bring it with you to your scheduled appointment.

Purpose:	This form is to familiarize Dr. Lecca with both your general and personal information, as well as medical history.

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		.doc - Microsoft Word - (requires Microsoft Word)

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